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Jamal L, May M, Setzer MR, Yu M, Berkman B, Similuk M. Research participants' perspectives about the return of uninformative genomic test results in a clinical research setting. J Genet Couns 2024; 33:689-698. [PMID: 37641538 PMCID: PMC10899523 DOI: 10.1002/jgc4.1772] [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: 09/12/2022] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
The majority of genomic sequencing and microarray results are clinically uninformative, meaning that they do not suggest a need for any behavioral action or medical intervention. Prior studies have shown that recipients of uninformative genomic testing results ("uninformative results" hereafter) may incorrectly interpret them to imply a lowered risk of disease or false reassurance about future health risks. Few studies have examined how patients understand uninformative results when they are returned in a research setting, where there is wide variation in analytical specifications of testing, interpretation and reporting practices, and resources to support the return of results. We conducted cross-sectional interviews (N = 17) to explore how a subset of research participants in one genomics study at the National Institutes of Health reacted to and understood their uninformative test results, which were returned to them via a patient portal without genetic counseling. We found that most participants did not remember the details of the informed consent process, including the distinction between "primary" and "secondary" findings. Participants had questions about what genes were tested for and, in most cases, requested a list of the genes covered. Several participants incorrectly assumed that autosomal recessive carrier results would have been reported to them if detected. Some participants interpreted their uninformative results to mean that they could forgo prenatal testing, and participants had mixed expectations about whether their results might be reinterpreted in the future. These themes suggest that there are specific challenges to returning uninformative results in research settings. Educational supplements to uninformative test reports may be most useful if they contextualize results in relation to other types of clinical genetic or genomic testing that may be made available to research participants in their lifetimes.
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Affiliation(s)
- Leila Jamal
- Center for Cancer Research, Genetics Branch, National Cancer Institute, Bethesda, Maryland
- NIH Clinical Center Department of Bioethics, Bethesda, Maryland
| | - Makenna May
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Medical Genetics and Genomics Branch, National Human Genome Research Institute, Bethesda, Maryland
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Michael R. Setzer
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Mary Yu
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Benjamin Berkman
- NIH Clinical Center Department of Bioethics, Bethesda, Maryland
- Bioethics Core, National Human Genome Research Institute, Bethesda, Maryland
| | - Morgan Similuk
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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Robertson EG, Komesaroff R, Eisenstat DD, Robertson A, Ludlow LE. A Pilot Evaluation of an Educational Video to Support Consent to a Pediatric Malignancy Biobank. Biopreserv Biobank 2024. [PMID: 38800954 DOI: 10.1089/bio.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Introduction: The collection of biological specimens is necessary to support basic and translational research. However, the complexity of biobanking introduces numerous ethical issues, particularly regarding informed consent. Objective: To evaluate the acceptability and perceived benefits of an educational video facilitating the consent process for the Children's Cancer Centre Biobank. Methods: We invited individuals who had previously consented to be (or their child to be) part of the Biobank, and health professionals who were involved in obtaining consent. Participants watched the video and completed a purpose-designed online survey. Results: A total of 16 health professionals (invited = 30) and 15 patients/caregivers (invited = 127) participated. Most patients/caregivers felt informed about the Biobank at consent, however, noted how overwhelmed they were at the time and that they did not engage with the written information. Overall, both patients/caregivers and health professionals rated the video favorably regarding the information provided and format. Participants valued that it was simple and clear, with several health professionals noting the need for linguistic translations to better support the families they work with. Most patients/caregivers agreed that the video provided enough information to begin considering participation. This aligned with the health professionals' feedback that the video was most effective when used as a conversation starter to help formalize the written consent. Conclusion: Our findings suggest that our video is an acceptable and beneficial tool to assist in the Biobank consenting process, from both the perspective of decision-makers and health professionals obtaining consent. It appears particularly valuable as a precursor to an interactive, formal consent discussion. Further work is required to determine whether our video has a significant impact on outcomes such as decision-making satisfaction and knowledge, and to determine the value to adolescents.
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Affiliation(s)
- Eden G Robertson
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Rebecca Komesaroff
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - David D Eisenstat
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Alexandra Robertson
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Louise E Ludlow
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Gafni-Amsalem C, Aboleil-Zoubi O, Chervinsky E, Aleme O, Khayat M, Bashir H, Perets LP, Mamluk E, Hakrosh S, Kurtzman S, Tamir L, Baram-Tsabari A, Shalev SA. Educational tools support informed decision-making for genetic carrier screening in a heterogenic Israeli population. J Community Genet 2024; 15:137-146. [PMID: 38114746 PMCID: PMC11031536 DOI: 10.1007/s12687-023-00694-4] [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: 02/28/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) aims to provide couples with information to make informed decisions. Since 2013, the Israeli Carrier Screening Program has been offered routinely and free of charge to all Israelis of reproductive age, personalized based on religion, ethnicity, and village/tribe where a disorder is frequent. This study evaluated the impact of two educational tools on an informed choice on RGCS uptake and satisfaction with counselling within a heterogeneous population in northern Israel. Participants from diverse sociodemographic population groups were randomly assigned to watch an animated film, read a booklet conveying the same information, or receive no information before counselling for RGCS, and asked to complete pre- and post-counselling questionnaires. A higher informed-decision rate was demonstrated in the film (n=93/141, 66%) and booklet (n=88/131, 67%) groups vs. the non-intervention group (n=62/143, 43%) (P<0.001), assessed by the Multidimensional Measure of Informed Choice. Multivariate logistic regression analysis revealed that allocation to an intervention group, Jewish ethnicity and higher education level, best predicted informed choice. Most participants expressed high levels of satisfaction with the counselling process, regardless of group assignment. While only a minority of participants reported seeking information prior to visiting the clinic, the pre-counselling information interventions were well accepted. Pre-counselling self-learning educational tools should be promoted, easily available, and adjusted linguistically and culturally to targeted populations, to avoid unwanted "automatic" compliance of tested individuals and maximize the potential of informed decision-making. Our study can be applied to other countries where majority and minority ethnic groups access genetic services.
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Affiliation(s)
- Chen Gafni-Amsalem
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel.
| | - Olfat Aboleil-Zoubi
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | | | - Ola Aleme
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | - Morad Khayat
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | - Husam Bashir
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | | | - Efrat Mamluk
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | - Shadia Hakrosh
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | - Shoshi Kurtzman
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | - Liron Tamir
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
| | | | - Stavit A Shalev
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Genetics Institute, Emek Medical Center, 18101, Afula, Israel
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4
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McInnes-Dean H, Mellis R, Daniel M, Walton H, Baple EL, Bertoli M, Fisher J, Gajewska-Knapik K, Holder-Espinasse M, Lafarge C, Leeson-Beevers K, McEwan A, Pandya P, Parker M, Peet S, Roberts L, Sankaran S, Smith A, Tapon D, Wu WH, Wynn SL, Chitty LS, Hill M, Peter M. 'Something that helped the whole picture': Experiences of parents offered rapid prenatal exome sequencing in routine clinical care in the English National Health Service. Prenat Diagn 2024; 44:465-479. [PMID: 38441167 DOI: 10.1002/pd.6537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England. This study aimed to explore parent experiences and their information and support needs from the perspective of parents offered pES and of health professionals involved in its delivery. METHODS In this qualitative study, semi-structured interviews were conducted with 42 women and 6 male partners and 63 fetal medicine and genetic health professionals. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Overall views about pES were positive and parents were grateful to be offered the test. Highlighted benefits of pES included the value of the additional information for pregnancy management and planning for future pregnancies. An anxious wait for results was common, often associated with the need to make decisions near to 24 weeks in pregnancy when there are legal restrictions for late termination. Descriptions of dealing with uncertainty were also common, even when results had been returned. Many parents described pES results as informing decision-making around whether or not to terminate pregnancy. Some professionals were concerned that a non-informative result could be overly reassuring and highlighted that careful counselling was needed to ensure parents have a good understanding of what the result means for their pregnancy. Emotional support from professionals was valued; however, some parents felt that post-test support was lacking. CONCLUSION Parents and professionals welcomed the introduction of pES. Results inform parents' decision-making around the termination of pregnancy. When there are no diagnostic findings or uncertain findings from pES, personalised counselling that considers scans and other tests are crucial. Directing parents to reliable online sources of information and providing emotional support throughout could improve their experiences of care.
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Affiliation(s)
- Hannah McInnes-Dean
- Antenatal Results and Choices, London, UK
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rhiannon Mellis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Morgan Daniel
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, London, UK
| | - Emma L Baple
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Peninsula Clinical Genetics Service, School, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | | | - Katarzyna Gajewska-Knapik
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Muriel Holder-Espinasse
- Clinical Genetics Department, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Caroline Lafarge
- School of Human and Social Sciences, University of West London, London, UK
| | | | - Alec McEwan
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals, Nottingham, UK
| | - Pranav Pandya
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals, London, UK
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | | | | | - Srividhya Sankaran
- School of Life Course and Population Sciences, Kings College London, St Thomas' Hospital, London, UK
- Department of Women and Children Health, Evelina Women & Children's Hospital Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Audrey Smith
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Dagmar Tapon
- Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Wing Han Wu
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sarah L Wynn
- Unique - Rare Chromosome Disorder Support Group, Oxted, UK
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michelle Peter
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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5
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Suckiel SA, Kelly NR, Odgis JA, Gallagher KM, Sebastin M, Bonini KE, Marathe PN, Brown K, Di Biase M, Ramos MA, Rodriguez JE, Scarimbolo L, Insel BJ, Ferar KDM, Zinberg RE, Diaz GA, Greally JM, Abul-Husn NS, Bauman LJ, Gelb BD, Horowitz CR, Wasserstein MP, Kenny EE. The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic results disclosure in diverse families. Am J Hum Genet 2023; 110:2029-2041. [PMID: 38006881 PMCID: PMC10716481 DOI: 10.1016/j.ajhg.2023.10.016] [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: 07/09/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/27/2023] Open
Abstract
Digital solutions are needed to support rapid increases in the application of genetic/genomic tests (GTs) in diverse clinical settings and patient populations. We developed GUÍA, a bilingual digital application that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GTs. The trial evaluated GUÍA's impact on understanding the GT results by randomizing families to results disclosure genetic counseling with GUÍA (intervention) or standard of care (SOC). Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6 months later. Survey measures assessed the primary study outcomes of participants' perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. The analysis included 551 diverse participants, 270 in the GUÍA arm and 281 in SOC. Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR = 2.8, CI[1.004, 7.617], p = 0.049) and maintained higher objective understanding over time (OR = 1.1, CI[1.004, 1.127], p = 0.038) compared to SOC. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR = 3.9, CI[1.603, 9.254], p = 0.003), confidence (OR = 2.7, CI[1.021, 7.277], p = 0.046), and objective understanding (OR = 1.1, CI[1.009, 1.212], p = 0.032) compared to SOC. This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions and builds a case for utilizing GUÍA to deliver complex results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics.
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Affiliation(s)
- Sabrina A Suckiel
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Nicole R Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Jacqueline A Odgis
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katie M Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Katherine E Bonini
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Priya N Marathe
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Miranda Di Biase
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jessica E Rodriguez
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laura Scarimbolo
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Beverly J Insel
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kathleen D M Ferar
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - John M Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laurie J Bauman
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY 10467, USA; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carol R Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Melissa P Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Eimear E Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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6
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Veney D, Wei L, Toland AE, Presley CJ, Hampel H, Padamsee TJ, Lee CN, Irvin WJ, Bishop M, Kim J, Hovick SR, Senter L, Stover DG. A Video Intervention to Improve Patient Understanding of Tumor Genomic Testing in Patients with Cancer. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299443. [PMID: 38106014 PMCID: PMC10723483 DOI: 10.1101/2023.12.05.23299443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Tumor genomic testing (TGT) has become standard-of-care for most patients with advanced/metastatic cancer. Despite established guidelines, patient education prior to TGT is variable or frequently omitted. The purpose of this study was to evaluate the impact of a concise (3-4 minute) video for patient education prior to TGT. Methods Based on a quality improvement cycle, an animated video was created to be applicable to any cancer type, incorporating culturally diverse images, available in English and Spanish. Patients undergoing standard-of care TGT were enrolled at a tertiary academic institution and completed validated survey instruments immediately prior to video viewing (T1) and immediately post-viewing (T2). Instruments included: 1) 10-question objective genomic knowledge/understanding; 2) 10-question video message-specific knowledge/recall; 3) 11-question Trust in Physician/Provider; 4) attitudes regarding TGT. The primary objective was change in outcomes from before to after the video was assessed with Wilcoxon signed rank test. Results From April 2022 to May 2023, a total of 150 participants were enrolled (MBC n=53, LC n=38, OC n=59). For the primary endpoint, there was a significant increase in video message-specific knowledge (median 10 point increase; p<0.0001) with no significant change in genomic knowledge/understanding (p=0.89) or Trust in Physician/Provider (p=0.59). Results for five questions significantly improved, including the likelihood of TGT impact on treatment decision, incidental germline findings, and cost of testing. Improvement in video message-specific knowledge was consistent across demographic groups, including age, income, and education. Individuals with less educational attainment had had greater improvement from before to after video viewing. Conclusions A concise, 3-4 minute, broadly applicable video incorporating culturally diverse images administered prior to TGT significantly improved video message-specific knowledge across all demographic groups. This resource is publicly available at http://www.tumor-testing.com, with a goal to efficiently educate and empower patients regarding TGT while addressing guidelines within the flow of clinical practice. Clinical Trial Registration ClinicalTrials.gov NCT05215769.
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Affiliation(s)
- Deloris Veney
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Lai Wei
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, 43210 USA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, 43210 USA
| | - Carolyn J. Presley
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010
| | - Tasleem J. Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Clara N. Lee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - William J. Irvin
- Bon Secours Cancer Institute at St. Francis, Richmond, Virginia, USA
| | | | - James Kim
- Bon Secours-Mercy Health St. Elizabeth, Youngstown, Ohio, USA
| | - Shelly R. Hovick
- School of Communication, Ohio State University, Columbus, OH, 43210 USA
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Daniel G. Stover
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, 43210 USA
- Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer, Columbus, OH, 43210 USA
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7
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Peter M, Hammond J, Sanderson SC, Gurasashvili J, Hunter A, Searle B, Patch C, Chitty LS, Hill M, Lewis C. Knowledge, attitudes and decision regret: a longitudinal survey study of participants offered genome sequencing in the 100,000 Genomes Project. Eur J Hum Genet 2023; 31:1407-1413. [PMID: 37789083 PMCID: PMC10689827 DOI: 10.1038/s41431-023-01470-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
We used cross-sectional surveys to compare the knowledge, attitudes, and decision regret of participants who had consented for genome sequencing (GS) for rare disease diagnosis in the 100,000 Genomes Project (100kGP) across two timepoints (at the time of consenting for GS (T1) and 12-18 months later (T2)). At T1, participants (n = 504) completed a survey that included measures of general knowledge of GS ("Knowledge of Genome Sequencing" (KOGS)), specific knowledge of GS and attitudes towards GS ("General attitudes" and "Specific attitudes"). At T2, participants (n = 296) completed these same assessments (apart from the specific knowledge scale) together with an assessment of decision regret towards GS ("Decisional Regret Scale"). At 12-18 months after consenting for GS, participants' basic knowledge of GS had remained stable. General knowledge of GS varied across topics; concepts underlying more general information about genetics were better understood than the technical details of genomic testing. Attitudes towards GS at T2 were generally positive, and feelings towards GS (both positive and negative) remained unchanged. However, those who were more positive about the test at the outset had greater specific knowledge (as opposed to general knowledge) of GS. Finally, although the majority of participants indicated feeling little regret towards undergoing GS, those with low positive attitude and high negative attitude about GS at T1 reported greater decision regret at T2. Careful assessment of patient knowledge about and attitudes towards GS at the time of offering testing is crucial for supporting informed decision making and mitigating later regret.
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Affiliation(s)
- Michelle Peter
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jennifer Hammond
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Saskia C Sanderson
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jana Gurasashvili
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Beverly Searle
- Unique - Rare Chromosome Disorder Support Group, Oxted, UK
| | - Christine Patch
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1RQ, UK
| | - Lyn S Chitty
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.
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8
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Suckiel SA, Kelly NR, Odgis JA, Gallagher KM, Sebastin M, Bonini KE, Marathe PN, Brown K, Di Biase M, Ramos MA, Rodriguez JE, Scarimbolo L, Insel BJ, Ferar KD, Zinberg RE, Diaz GA, Greally JM, Abul-Husn NS, Bauman LJ, Gelb BD, Horowitz CR, Wasserstein MP, Kenny EE. The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic counseling in racially and ethnically diverse families. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.05.23292193. [PMID: 37461450 PMCID: PMC10350148 DOI: 10.1101/2023.07.05.23292193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Digital solutions are needed to support rapid increases in the application of genetic and genomic tests (GT) in diverse clinical settings and patient populations. We developed GUÍA, a bi-lingual web-based platform that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial evaluated GUÍA's impact on understanding of GT results. Methods NYCKidSeq enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GT. Families were randomized to genetic counseling with GUÍA (intervention) or standard of care (SOC) genetic counseling for results disclosure. Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6-months later. Survey measures assessed the primary study outcomes of perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. We used regression models to evaluate the association between the intervention and the study outcomes. Results The analysis included 551 participants, 270 in the GUÍA arm and 281 in SOC. Participants' mean age was 41.1 years and 88.6% were mothers. Most participants were Hispanic/Latino(a) (46.3%), White/European American (24.5%), or Black/African American (15.8%). Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR=2.8, CI[1.004,7.617], P=0.049) and maintained higher objective understanding over time (OR=1.1, CI[1.004, 1.127], P=0.038) compared to those in the SOC arm. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR=3.9, CI[1.6, 9.3], P=0.003), confidence (OR=2.7, CI[1.021, 7.277], P=0.046), and objective understanding (OR=1.1, CI[1.009, 1.212], P=0.032) compared to SOC . Conclusions This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions. These findings build a case for utilizing GUÍA to deliver complex and often ambiguous genetic results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics. Trial Registration Clinicaltrials.gov identifier NCT03738098.
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Affiliation(s)
- Sabrina A. Suckiel
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nicole R. Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Jacqueline A. Odgis
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katie M. Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Katherine E. Bonini
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Priya N. Marathe
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Miranda Di Biase
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Michelle A. Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jessica E. Rodriguez
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Scarimbolo
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Beverly J. Insel
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathleen D.M. Ferar
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Randi E. Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George A. Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John M. Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Noura S. Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laurie J. Bauman
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Bruce D. Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carol R. Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa P. Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children’s Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Eimear E. Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Feeley TH, Keller M, Kayler L. Using Animated Videos to Increase Patient Knowledge: A Meta-Analytic Review. HEALTH EDUCATION & BEHAVIOR 2023; 50:240-249. [PMID: 35950326 DOI: 10.1177/10901981221116791] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article meta-analyzed 21 studies that tested the effectiveness of animated videos in improving learning in clinical and nonclinical settings compared with standard education. Animation was defined as the use of moving objects that are typically drawn or simulated. Videos ranged from just over 2 min in duration to 16 min in duration in articles published from 2009 through 2020. Mayer's Cognitive Theory of Multimedia Learning provided the theoretical model to frame the current analyses. Findings indicated an overall positive effect (d = 0.35) for use of animation in improving viewers' learning across a variety of health and clinical contexts, including surgery and diabetes. Moderator analyses indicated learning effects were greater in patient samples and samples with a higher proportion of male participants. Study findings were discussed in terms of the theoretical and practical implications for health communication scholars and practitioners.
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Affiliation(s)
- Thomas Hugh Feeley
- University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Maria Keller
- University at Buffalo, The State University of New York, Buffalo, NY, USA.,Erie County Medical Center, Buffalo, NY, USA
| | - Liise Kayler
- University at Buffalo, The State University of New York, Buffalo, NY, USA.,Erie County Medical Center, Buffalo, NY, USA
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10
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Sebastin M, Odgis JA, Suckiel SA, Bonini KE, Di Biase M, Brown K, Marathe P, Kelly NR, Ramos MA, Rodriguez JE, Aguiñiga KL, Lopez J, Maria E, Rodriguez MA, Yelton NM, Cunningham-Rundles C, Gallagher K, McDonald TV, McGoldrick PE, Robinson M, Rubinstein A, Shulman LH, Wolf SM, Yozawitz E, Zinberg RE, Abul-Husn NS, Bauman LJ, Diaz GA, Ferket BS, Greally JM, Jobanputra V, Gelb BD, Horowitz CR, Kenny EE, Wasserstein MP. The TeleKidSeq pilot study: incorporating telehealth into clinical care of children from diverse backgrounds undergoing whole genome sequencing. Pilot Feasibility Stud 2023; 9:47. [PMID: 36949526 PMCID: PMC10031704 DOI: 10.1186/s40814-023-01259-5] [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: 10/18/2021] [Accepted: 02/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced healthcare institutions and many clinical research programs to adopt telehealth modalities in order to mitigate viral spread. With the expanded use of telehealth, there is the potential to increase access to genomic medicine to medically underserved populations, yet little is known about how best to communicate genomic results via telehealth while also ensuring equitable access. NYCKidSeq, a multi-institutional clinical genomics research program in New York City, launched the TeleKidSeq pilot study to assess alternative forms of genomic communication and telehealth service delivery models with families from medically underserved populations. METHODS We aim to enroll 496 participants between 0 and 21 years old to receive clinical genome sequencing. These individuals have a neurologic, cardiovascular, and/or immunologic disease. Participants will be English- or Spanish-speaking and predominantly from underrepresented groups who receive care in the New York metropolitan area. Prior to enrollment, participants will be randomized to either genetic counseling via videoconferencing with screen-sharing or genetic counseling via videoconferencing without screen-sharing. Using surveys administered at baseline, results disclosure, and 6-months post-results disclosure, we will evaluate the impact of the use of screen-sharing on participant understanding, satisfaction, and uptake of medical recommendations, as well as the psychological and socioeconomic implications of obtaining genome sequencing. Clinical utility, cost, and diagnostic yield of genome sequencing will also be assessed. DISCUSSION The TeleKidSeq pilot study will contribute to innovations in communicating genomic test results to diverse populations through telehealth technology. In conjunction with NYCKidSeq, this work will inform best practices for the implementation of genomic medicine in diverse, English- and Spanish-speaking populations.
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Affiliation(s)
- Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Jacqueline A Odgis
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Bonini
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miranda Di Biase
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Priya Marathe
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole R Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica E Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karla López Aguiñiga
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessenia Lopez
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Estefany Maria
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Michelle A Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole M Yelton
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Thomas V McDonald
- Department of Medicine (Cardiology), Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia E McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | | | - Arye Rubinstein
- Department of Allergy and Immunology, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa H Shulman
- Department of Pediatrics, Division of Developmental Medicine, Rose F. Kennedy Children's Evaluation & Rehabilitation Center at Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven M Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noura S Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Pediatrics, Division of Ambulatory Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - George A Diaz
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Vaidehi Jobanputra
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Bruce D Gelb
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eimear E Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA.
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11
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Katz ML, Senter L, Reiter PL, Emerson B, Ennis AC, Shane-Carson KP, Aeilts A, Cassingham HR, Schnell PM, Agnese DM, Toland AE, Sweet K. Development of a web-based, theory-guided narrative intervention for women at elevated risk for breast cancer. PATIENT EDUCATION AND COUNSELING 2023; 106:163-169. [PMID: 36333195 PMCID: PMC10395484 DOI: 10.1016/j.pec.2022.10.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the development of a web-based, theory-guided narrative intervention that replaces conventional pre-test genetic counseling for women at elevated breast cancer risk. METHODS We used an iterative process that was guided by health behavior theory and feedback from multiple stakeholder groups including: 1) content input from genetic experts; 2) study team input; 3) review of video storyboards, video example, study logo, recruitment materials, post-test patient preference counseling survey, and additional study surveys; 4) video series development; and 5) intervention review and finalization of study-related materials. RESULTS The intervention is patient-centered providing convenience and an opportunity for an individual's preferences for post-test counseling delivery. The intervention's efficacy is being determined in a randomized controlled trial compared to conventional genetic counseling for adherence to recommended guidelines and changes in knowledge, perception of breast cancer risk, breast cancer-specific worry, and satisfaction with counseling. CONCLUSION If efficacious, the intervention may improve the delivery of the genetic testing and counseling process, inform best practices, and reduce the genetic counseling workforce burden. PRACTICE IMPLICATIONS The developed intervention has the potential to improve the genetic testing and counseling experience for women at elevated risk for breast cancer, inform best practices, and reduce genetic counseling workforce burden.
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Affiliation(s)
- Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alysha C Ennis
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kate P Shane-Carson
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amber Aeilts
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Hayley R Cassingham
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Doreen M Agnese
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amanda E Toland
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kevin Sweet
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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12
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Senter L, Veney D, Surplus T, Haynam M, Adams EJ, Hampel H, Toland AE, Presley CJ, Padamsee TJ, Lee CN, Hovick SR, Stover DG. Patient Understanding of Tumor Genomic Testing: A Quality Improvement Effort. JCO Oncol Pract 2023; 19:e8-e14. [PMID: 36130146 PMCID: PMC10166357 DOI: 10.1200/op.22.00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/29/2022] [Accepted: 08/16/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Tumor genomic testing (TGT) has become increasingly adopted as part of standard cancer care for many cancers. Despite national guidelines around patient education before TGT, available evidence suggests that most patients' understanding of genomics remains limited, particularly lower-income and minority patients, and most patients are not informed regarding potential incidental germline findings. METHODS To investigate and address limitations in patient understanding of TGT results, a Plan-Do-Study-Act (PDSA) approach is being used to assess needs, identify opportunities for improvement, and implement approaches to optimize patient education. We reviewed published guidelines related to pre-TGT provider-patient education and to identify key points (Plan). A provider quality improvement survey was completed (Do), which highlighted inconsistency in pre-TGT discussion practice across providers and minimal discussion with patients regarding the possibility of incidental germline findings. RESULTS Patient focus groups and interviews (N = 12 patients) were completed with coding of each transcript (Study), which revealed themes including trouble differentiating TGT from other forms of testing, yet understanding that results could tailor therapy. The integration of data across this initial PDSA cycle identified consistent themes and opportunities, which were incorporated into a patient-directed, concise animated video for pre-TGT education (Act), which will form the foundation of a subsequent PDSA cycle. The video addresses how TGT may/may not inform treatment, the process for TGT using existing tissue or liquid biopsy, insurance coverage, and the potential need for germline genetics follow-up because of incidental findings. CONCLUSION This PDSA cycle reveals key gaps and opportunities for improvement in patient education before TGT.
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Affiliation(s)
- Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Deloris Veney
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Taylor Surplus
- School of Communication, Ohio State University, Columbus, OH
| | - Marcy Haynam
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Elizabeth J. Adams
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Clinical Cancer Genomics, Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH
| | - Carolyn J. Presley
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tasleem J. Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
| | - Clara N. Lee
- Recruitment, Intervention and Survey Shared Resource, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Daniel G. Stover
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
- Department of Biomedical Informatics, Ohio State University, Columbus, OH
- Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer, Columbus, OH
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13
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Lynch JA, Idleburg MJ, Butsch Kovacic M, Childers-Buschle KE, Dufendach KR, Lipstein EA, McGowan ML, Myers MF, Prows CA. Developing video education materials for the return of genomic test results to parents and adolescents. PEC INNOVATION 2022; 1:100051. [PMID: 36532300 PMCID: PMC9757811 DOI: 10.1016/j.pecinn.2022.100051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the development, implementation, and revision of a video to provide information about genomic testing and the return of genomic research results to adolescents and parents. METHODS Formative, community-engaged research was conducted in three stages: development, implementation, and revision. Existing research participant advisory groups were used for focus groups and convenience sampling was used for interviews. Participants included parents, young adults without children, and adolescents. Transcripts of recorded sessions were used for formative analysis. RESULTS Video was the preferred format for delivering genomic testing information to adolescents during the development stage. During implementation, adolescents identified video length as an impediment to recall. During the revision stage, participants preferred the video in separate short segments, supported plan to require only one short video and leaving other short videos optional. Participants were divided on whether the required short video provided enough information, but all participants reported that watching additional videos would not have changed their decisions about receiving test results. CONCLUSION Genomic education videos should be brief (<4 mins) to improve the odds that participants will view the entirety of any required video. INNOVATION The development of participant materials should incorporate plans for monitoring implementation and plans for revising materials.
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Affiliation(s)
- John A. Lynch
- Department of Communication, College of Arts & Sciences, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Michaela J. Idleburg
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Melinda Butsch Kovacic
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Rehabilitation, Exercise, and Nutrition Science, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | | | - Kevin R. Dufendach
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ellen A. Lipstein
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Michelle L. McGowan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Women’s, Gender & Sexuality Studies, College of Arts & Sciences, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Melanie F. Myers
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Cynthia A. Prows
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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14
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Butow P, Napier C, Campbell R, Bartley N, Best M, Ballinger ML. Validation of the Knowledge of Genome Sequencing (KOGS) scale in cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:3110-3115. [PMID: 35738962 DOI: 10.1016/j.pec.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The Knowledge of Genome Sequencing (KOGS) questionnaire was recently developed to measure knowledge of genomic sequencing (GS), with preliminary psychometric data supporting its reliability and validity. The aim of this study was to test the reliability and validity of the KOGS in a larger sample, and to confirm its utility in a cancer setting. METHODS The Genetic Cancer Risk in the Young (RisC) study recruits participants with a personal history of cancer, to investigate heritable cancer causes and future cancer risk using germline GS. Participants (n = 261) in a psychosocial substudy of RisC completed a questionnaire after consent to RisC but before GS, including the KOGS, the Intolerance of Uncertainty Scale, the Chew health literacy scale and items assessing demographic and disease variables. Confirmatory factor analysis (CFA), Cronbach alpha and correlational analyses were undertaken. RESULTS The CFA testing a single-factor model yielded a good model fit, χ2/df = 2.43, comparative fit index (CFI) = 0.97, root mean square error of approximation (RMSEA) = 0.07 and weighted mean root square (WRMR) = 1.03. Factor loadings of all items were above 0.60 and ranged between.66 and.93. The single factor score demonstrated excellent internal consistency (α = 0.82). KOGS scores were significantly associated with health literacy (r = 0.23, p < .001), having a university education [t(258) = -4.53, p < .001] and having a medical or science background [t(259) = -3.52, p < .001] but not with speaking a language other than English at home, time since diagnosis, previous genetic counselling/testing or intolerance of uncertainty. DISCUSSION This study confirmed a single-factor structure for the KOGS, and its reliability and validity in a cancer population. Associations with measures of health literacy and education were significant and positive as expected, supporting the KOG's construct validity. Previous genetic counselling may not be sufficient to provide specific knowledge of GS.
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Affiliation(s)
- P Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia.
| | - C Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - R Campbell
- The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Medicine (CeMPED), Australia
| | - N Bartley
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - M Best
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Notre Dame Australia, Institute for Ethics and Society, Sydney, Australia
| | - M L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; University of NSW, St Vincent's Clinical School, Sydney, Australia
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15
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Hammond J, Garner I, Hill M, Patch C, Hunter A, Searle B, Sanderson SC, Lewis C. Animation or leaflet: Does it make a difference when educating young people about genome sequencing? PATIENT EDUCATION AND COUNSELING 2021; 104:2522-2530. [PMID: 33678496 DOI: 10.1016/j.pec.2021.02.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the effectiveness of an animation against two leaflets with and without images, in educating young people about genome sequencing (GS). METHODS An experimental survey with three assessment points (pre- intervention [T1], post - intervention [T2], 6-week follow-up [T3]). Participants (N = 606) were randomly assigned to receive one of three educational interventions; animation (n = 212); leaflet with images (n = 197); or leaflet with text only (n = 197). Measures of objective and subjective knowledge were completed at T1 (N = 606), T2 (N = 606) and T3 (N = 459). Measures of attitudes, intentions and beliefs towards GS and satisfaction with intervention were completed at T2 only. RESULTS The type of educational intervention young people received had no significant impact on their objective or subjective knowledge at both T2 and T3 (all p > .05), nor did the educational intervention type affect their attitudes, intentions and beliefs towards GS at T2 (p > .05). However, participant satisfaction was significantly higher in the animation group than the leaflet groups (p < .001). CONCLUSION Animations and leaflets are both effective ways to deliver genomic education to young people, but the animations lead to higher satisfaction. PRACTICE IMPLICATIONS Different individuals may find different modes of educational resources more accessible than others. Therefore a range of resources should ideally be made available to patients.
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Affiliation(s)
- Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ian Garner
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christine Patch
- Genomics England, Queen Mary University of London, Dawson Hall, London, UK; Counselling, Society and Ethics Research, Wellcome Genome Campus, Hinxton, Cambridge, UK; Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, UK
| | | | - Beverly Searle
- Unique - The Rare Chromosome Disorder Support Group, Oxted, UK
| | - Saskia C Sanderson
- Early Disease Detection Research Project UK (EDDRP UK), London, UK; Department of Behavioural Science and Health, University College London, London, UK; PHG Foundation, Cambridge, UK
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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16
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Lindberg NM, Gutierrez AM, Mittendorf KF, Ramos MA, Anguiano B, Angelo F, Joseph G. Creating accessible Spanish language materials for Clinical Sequencing Evidence-Generating Research consortium genomic projects: challenges and lessons learned. Per Med 2021; 18:441-454. [PMID: 34448595 PMCID: PMC8438935 DOI: 10.2217/pme-2020-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2021] [Indexed: 01/31/2023]
Abstract
Aim: To increase Spanish speakers' representation in genomics research, accessible study materials on genetic topics must be made available in Spanish. Materials & methods: The Clinical Sequencing Evidence-Generating Research consortium is evaluating genome sequencing for underserved populations. All sites needed Spanish translation of recruitment materials, surveys and return of results. Results: We describe our process for translating site-specific materials, as well as shared measures across sites, to inform future efforts to engage Spanish speakers in research. Conclusion: In translating and adapting study materials for roughly 1000 Spanish speakers across the USA, and harmonizing translated measures across diverse sites, we overcame numerous challenges. Translation should be performed by professionals. Studies must allocate sufficient time, effort and budget to translate and adapt participant materials.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Amanda M Gutierrez
- Baylor College of Medicine Center for Medical Ethics & Health Policy, One Baylor Plaza, Suite 310D, Houston, TX 77030, USA
| | - Kathleen F Mittendorf
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Michelle A Ramos
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA
| | - Beatriz Anguiano
- University of California, San Francisco (UCSF) Program in Bioethics, 3333 California Ave (suite 340), San Francisco, CA 94606, USA
| | - Frank Angelo
- CSER Coordinating Center, University of Washington, Division of Medical Genetics, Health Sciences Building, K-253 Box 357720 Seattle, WA 98195, USA
| | - Galen Joseph
- University of California San Francisco Department of Humanities & Social Sciences, 1450 3rd Street, Rm. 551 San Francisco, CA 94143, USA
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17
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Milo Rasouly H, Aggarwal V, Bier L, Goldstein DB, Gharavi AG. Cases in Precision Medicine: Genetic Testing to Predict Future Risk for Disease in a Healthy Patient. Ann Intern Med 2021; 174:540-547. [PMID: 33460345 DOI: 10.7326/m20-5713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Genetic testing is performed more routinely in clinical practice, and direct-to-consumer tests are widely available. It has obvious appeal as a preventive health measure. Clinicians and their healthy patients increasingly inquire about genetic testing as a tool for predicting diseases, such as cancer, heart disease, or dementia. Despite demonstrated utility for diagnosis in the setting of many diseases, genetic testing still has many limitations as a predictive tool for healthy persons. This article uses a hypothetical case to review key considerations for predictive genetic testing.
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Affiliation(s)
- Hila Milo Rasouly
- Columbia University Irving Medical Center, New York, New York (H.M.R., A.G.G.)
| | - Vimla Aggarwal
- Hammer Health Sciences, New York, New York (V.A., L.B., D.B.G.)
| | - Louise Bier
- Hammer Health Sciences, New York, New York (V.A., L.B., D.B.G.)
| | | | - Ali G Gharavi
- Columbia University Irving Medical Center, New York, New York (H.M.R., A.G.G.)
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18
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Odgis JA, Gallagher KM, Suckiel SA, Donohue KE, Ramos MA, Kelly NR, Bertier G, Blackburn C, Brown K, Fielding L, Lopez J, Aguiniga KL, Maria E, Rodriguez JE, Sebastin M, Teitelman N, Watnick D, Yelton NM, Abhyankar A, Abul-Husn NS, Baum A, Bauman LJ, Beal JC, Bloom T, Cunningham-Rundles C, Diaz GA, Dolan S, Ferket BS, Jobanputra V, Kovatch P, McDonald TV, McGoldrick PE, Rhodes R, Rinke ML, Robinson M, Rubinstein A, Shulman LH, Stolte C, Wolf SM, Yozawitz E, Zinberg RE, Greally JM, Gelb BD, Horowitz CR, Wasserstein MP, Kenny EE. The NYCKidSeq project: study protocol for a randomized controlled trial incorporating genomics into the clinical care of diverse New York City children. Trials 2021; 22:56. [PMID: 33446240 PMCID: PMC7807444 DOI: 10.1186/s13063-020-04953-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasingly, genomics is informing clinical practice, but challenges remain for medical professionals lacking genetics expertise, and in access to and clinical utility of genomic testing for minority and underrepresented populations. The latter is a particularly pernicious problem due to the historical lack of inclusion of racially and ethnically diverse populations in genomic research and genomic medicine. A further challenge is the rapidly changing landscape of genetic tests and considerations of cost, interpretation, and diagnostic yield for emerging modalities like whole-genome sequencing. METHODS The NYCKidSeq project is a randomized controlled trial recruiting 1130 children and young adults predominantly from Harlem and the Bronx with suspected genetic disorders in three disease categories: neurologic, cardiovascular, and immunologic. Two clinical genetic tests will be performed for each participant, either proband, duo, or trio whole-genome sequencing (depending on sample availability) and proband targeted gene panels. Clinical utility, cost, and diagnostic yield of both testing modalities will be assessed. This study will evaluate the use of a novel, digital platform (GUÍA) to digitize the return of genomic results experience and improve participant understanding for English- and Spanish-speaking families. Surveys will collect data at three study visits: baseline (0 months), result disclosure visit (ROR1, + 3 months), and follow-up visit (ROR2, + 9 months). Outcomes will assess parental understanding of and attitudes toward receiving genomic results for their child and behavioral, psychological, and social impact of results. We will also conduct a pilot study to assess a digital tool called GenomeDiver designed to enhance communication between clinicians and genetic testing labs. We will evaluate GenomeDiver's ability to increase the diagnostic yield compared to standard practices, improve clinician's ability to perform targeted reverse phenotyping, and increase the efficiency of genetic testing lab personnel. DISCUSSION The NYCKidSeq project will contribute to the innovations and best practices in communicating genomic test results to diverse populations. This work will inform strategies for implementing genomic medicine in health systems serving diverse populations using methods that are clinically useful, technologically savvy, culturally sensitive, and ethically sound. TRIAL REGISTRATION ClinicalTrials.gov NCT03738098 . Registered on November 13, 2018 Trial Sponsor: Icahn School of Medicine at Mount Sinai Contact Name: Eimear Kenny, PhD (Principal Investigator) Address: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1003, New York, NY 10029 Email: eimear.kenny@mssm.edu.
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Affiliation(s)
- Jacqueline A Odgis
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie M Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Donohue
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole R Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gabrielle Bertier
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Blackburn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lena Fielding
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Jessenia Lopez
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karla Lopez Aguiniga
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Estefany Maria
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica E Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nehama Teitelman
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dana Watnick
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole M Yelton
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Noura S Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Baum
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jules C Beal
- Department of Pediatrics, Division of Child Neurology, Weill Cornell Medical, New York, NY, USA
| | - Toby Bloom
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Siobhan Dolan
- Department of Obstetrics and Gynecology and Women's Health (Reproductive and Medical Genetics), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaidehi Jobanputra
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Patricia Kovatch
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Scientific Computing and Data Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas V McDonald
- Department of Medicine (Cardiology), Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia E McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Rosamond Rhodes
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael L Rinke
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Arye Rubinstein
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa H Shulman
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christian Stolte
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Steven M Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Elissa Yozawitz
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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19
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Milo Rasouly H, Cuneo N, Marasa M, DeMaria N, Chatterjee D, Thompson JJ, Fasel DA, Wynn J, Chung WK, Appelbaum P, Weng C, Bakken S, Gharavi AG. GeneLiFT: A novel test to facilitate rapid screening of genetic literacy in a diverse population undergoing genetic testing. J Genet Couns 2020; 30:742-754. [PMID: 33368851 PMCID: PMC8246865 DOI: 10.1002/jgc4.1364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 11/05/2022]
Abstract
With the broader introduction of genomic medicine in research and clinical care, an increasing number of persons are offered genetic testing. Many factors, including genetic literacy, may impact the utilization of genetic results by patients and their families. We developed a rapid, self-administered measure of genetic literacy, called Genetic Literacy Fast Test (GeneLiFT). We next evaluated the association of GeneLiFT scores with the comprehension of limitations of genomic medicine in participants undergoing genetic testing in the NIH-sponsored eMERGE III study at Columbia University Irving Medical Center, New York. All participants underwent genetic screening for variants in 74 actionable genes associated with adult-onset disorders. A diverse cohort of 724 participants completed the survey (60% women, 45% less than 40 years old, and 53% self-reported White non-Hispanic ancestry). The GeneLiFT was validated using known group differences based on education, health literacy, and numeracy, and with questions assessing genetic knowledge. GeneLiFT identified multiple standard genetics terms, that is, jargon, not recognized by more than 50% of participants (including actionability and pathogenicity). Low genetic literacy, identified in 210 participants (29%), was significantly associated with poor understanding of the limitations of genetic testing (p-values < 10-9 ). This association was independent of education, health literacy, and numeracy levels, highlighting the importance of directly measuring genetic literacy. Low genetic literacy was also associated with low satisfaction with the informed consent process. GeneLiFT is a practical tool for rapid assessment of genetic literacy in large studies or clinical care. GeneLiFT will allow future research to efficiently assess the role of genetic literacy on the clinical impact of genetic testing.
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Affiliation(s)
- Hila Milo Rasouly
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nicole Cuneo
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Maddalena Marasa
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Natalia DeMaria
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Debanjana Chatterjee
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jacqueline J Thompson
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - David A Fasel
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Wynn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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20
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Galindo-Neto NM, Lima MB, Barros LM, Santos SCD, Caetano JÁ. Sign language instrument for assessing the knowledge of deaf people about Cardiopulmonary Resuscitation. Rev Lat Am Enfermagem 2020; 28:e3283. [PMID: 32520239 PMCID: PMC7282720 DOI: 10.1590/1518-8345.3535.3283] [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: 05/07/2019] [Accepted: 05/06/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to build and validate the content on Cardiopulmonary Resuscitation (CPR) of a
sign language instrument for assessing the knowledge of the deaf. Method: methodological study in which the content validity process was used by 22
specialists in cardiac arrest and 16 deaf people. In the validation of
internal consistency, 113 deaf people participated. For the assessment of
the deaf, the Assistive Technology Assessment Questionnaire was used and, in
the content validity, an instrument with a Likert scale was used, which
included the content, clarity, objectivity, organization and language. Items
with a minimum agreement of 80% were considered valid, according to the
Content Validity Index (CVI) and binomial test. The internal consistency was
verified by Cronbach’s alpha. Results: The instrument contains 11 questions about the identification of
cardiorespiratory arrest, activation by aid and high quality chest
compression. It had a minimum content validity of 81% by the specialists,
90% by the deaf participants and internal consistency by the Cronbach alpha
of 0.86, being considered high. Conclusion: the instrument can be used in research to survey the previous knowledge of
deaf people about CPR, as well as in pre and/or post-testing studies that
test educational interventions with this public.
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Affiliation(s)
- Nelson Miguel Galindo-Neto
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco (IFPE), Campus Pesqueira, Pesqueira, PE, Brazil
| | - Magno Batista Lima
- Universidade Federal do Piauí, Colégio Técnico de Bom Jesus, Bom Jesus, PI, Brazil
| | - Lívia Moreira Barros
- Universidade Estadual Vale do Acaraú, Departamento de Enfermagem, Sobral, CE, Brazil
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21
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East KM, Cochran M, Kelley WV, Greve V, Emmerson K, Raines G, Cochran JN, Hott AM, Bick D. Understanding the present and preparing for the future: Exploring the needs of diagnostic and elective genomic medicine patients. J Genet Couns 2020; 28:438-448. [PMID: 30964585 DOI: 10.1002/jgc4.1114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Advances in genomic knowledge and technology have increased the use of comprehensive clinical sequencing tests. Genome sequencing has established utility for diagnosing patients with rare, undiagnosed diseases as well as interest in an elective context, without a clinical indication for testing. The Smith Family Clinic for Genomic Medicine, LLC in Huntsville, AL is a private practice genomic medicine clinic caring for both diagnostic (79%) and elective (21%) patients. Diagnostic and elective patients are seen on a clinical basis and receive standard care. Genome sequencing is provided on a self-pay basis, with assistance available for diagnostic patients who have financial need. Here, we describe demographics and motivations of the distinct patient populations and our experiences engaging patients in online education. Diagnostic patients were motivated by the possibility of receiving an explanation for symptoms (96%) while elective patients were motivated by the chance to learn about future disease risk (57%). Elective patients were less likely to engage with online education, with only 28% reading all assigned topics compared to 54% of diagnostic patients. Understanding the needs, interests, and barriers unique to diagnostic and elective patients is critical to inform individualized and scalable best practices in patient education and engagement.
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Affiliation(s)
- Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Meagan Cochran
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Veronica Greve
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Grace Raines
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Adam M Hott
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - David Bick
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
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Rashkin MD, Bowes J, Dunaway K, Dhaliwal J, Loomis E, Riffle S, Washington NL, Ziegler C, Lu J, Levin E. Genetic counseling, 2030: An on-demand service tailored to the needs of a price conscious, genetically literate, and busy world. J Genet Couns 2020; 28:456-465. [PMID: 30964579 DOI: 10.1002/jgc4.1123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
The practice of genetic counseling is going to be impacted by the public's expectation that goods, services, information, and experiences happen on demand, wherever and whenever people want them. Building from trends that are currently taking shape, this article looks just over a decade into the future-to 2030-to provide a description of how the field of genetics and genetic counseling will be changed, as well as advice for genetic counselors for how to prepare. We build from the prediction that a large portion of the general public will have access to their digitized whole genome sequence anytime, any place, on any device. We focus on five topics downstream of this prediction: public health, personal autonomy, polygenic scores (PGS), evolving clinical practices, and genetic privacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - James Lu
- Helix Opco, LLC, San Carlos, California
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23
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Wynn J, Wei W, Li X, So YS, Bakken S, Weng C, Chung WK. User engagement with web-based genomics education videos and implications for designing scalable patient education materials. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2020; 2019:923-932. [PMID: 32308889 PMCID: PMC7153116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Genomic medicine has created an urgent need for scalable genomic education. One promising approach is self-guided learning platforms. Understanding how these platforms are used is critical to guide their effective development and implementation. This study contributes a log-based method to study user engagement with online genomic educational videos among participants in a genomic screening study. We collected baseline demographics, logged participant usage and compared pre- and post-education genomic knowledge. Participants (N=390) who chose website access differed from those who declined access (N=81) and were more likely to be non-Latino, English speaking, younger, and have higher educational attainment. Only 45% who accessed the website viewed at least one video. The average video exposure time was 12 minutes. Longer exposure was not associated with an improvement in the user's genomic knowledge. Our study and future studies of user analytics should be used to guide the development of effective, scalable genomic education methods.
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Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
- Ms. Wynn and Dr. Wei contributed equally to this work b Dr. Chung and Dr. Weng contributed equally to this work
| | - Wei Wei
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Ms. Wynn and Dr. Wei contributed equally to this work b Dr. Chung and Dr. Weng contributed equally to this work
| | - Xinhang Li
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Yat S So
- Irving Institute of Clinical and Translational Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- School of Nursing, Columbia University Irving Medical Center, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Dr. Chung and Dr. Weng contributed equally to this work
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Dr. Chung and Dr. Weng contributed equally to this work
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24
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Development and mixed-methods evaluation of an online animation for young people about genome sequencing. Eur J Hum Genet 2020; 28:896-906. [PMID: 31896776 PMCID: PMC7316978 DOI: 10.1038/s41431-019-0564-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/08/2022] Open
Abstract
Children and young people with rare and inherited diseases will be significant beneficiaries of genome sequencing. However, most educational resources are developed for adults. To address this gap in informational resources, we have co-designed, developed and evaluated an educational resource about genome sequencing for young people. The first animation explains what a genome is, genomic variation and genome sequencing ("My Genome Sequence": http://bit.ly/mygenomesequence), the second focuses on the limitations and uncertainties of genome sequencing ("My Genome Sequence part 2": http://bit.ly/mygenomesequence2). In total, 554 school pupils (11-15 years) took part in the quantitative evaluation. Mean objective knowledge increased from before to after watching one or both animations (4.24 vs 7.60 respectively; t = 32.16, p < 0.001). Self-rated awareness and understanding of the words 'genome' and 'genome sequencing' increased significantly after watching the animation. Most pupils felt they understood the benefits of sequencing after watching one (75.4%) or both animations (76.6%). Only 17.3% felt they understood the limitations and uncertainties after watching the first, however this was higher among those watching both (58.5%, p < 0.001). Twelve young people, 14 parents and 3 health professionals consenting in the 100,000 Genomes Project reported that the animation was clear and engaging, eased concerns about the process and empowered young people to take an active role in decision-making. To increase accessibility, subtitles in other languages could be added, and the script could be made available in a leaflet format for those that do not have internet access. Future research could focus on formally evaluating the animations in a clinical setting.
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25
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Hernan R, Cho MT, Wilson AL, Ahimaz P, Au C, Berger SM, Guzman E, Primiano M, Shaw JE, Ross M, Tabanfar L, Chilton I, Griffin E, Ratner C, Anyane-Yeboa K, Iglesias A, Pisani L, Roohi J, Duong J, Martinez J, Appelbaum P, Klitzman R, Ottman R, Chung WK, Wynn J. Impact of patient education videos on genetic counseling outcomes after exome sequencing. PATIENT EDUCATION AND COUNSELING 2020; 103:127-135. [PMID: 31521424 PMCID: PMC9667716 DOI: 10.1016/j.pec.2019.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Growing use of clinical exome sequencing (CES) has led to an increased burden of genomic education. Self-guided educational tools can minimize the educational burden for genetic counselors (GCs). The effectiveness of these tools must be evaluated. METHODS Parents of patients offered CES were randomized to watch educational videos before their visit or to receive routine care. Parents and GCs were surveyed about their experiences following the sessions. The responses of the video (n = 102) and no-video (n = 105) groups were compared. RESULTS GCs reported no significant differences between parents in the video and no-video groups on genetics knowledge or CES knowledge. In contrast, parents' scores on genetics knowledge questions were lower in the video than no-video group (p = 0.007). Most parents reported the videos were informative, and the groups did not differ in satisfaction with GCs or decisions to have CES. CONCLUSION GCs and parents perceived the videos to be beneficial. However, lower scores on genetics knowledge questions highlight the need for careful development of educational tools. PRACTICE IMPLICATIONS Educational tools should be developed and assessed for effectiveness with the input of all stakeholders before widespread implementation. Better measures of the effectiveness of these educational tools are needed.
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Affiliation(s)
- Rebecca Hernan
- Sarah Lawrence College, Joan H. Marks Graduate Program in Human Genetics, Bronxville, NY, USA; Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan T Cho
- Sarah Lawrence College, Joan H. Marks Graduate Program in Human Genetics, Bronxville, NY, USA; GeneDx, 207 Perry Parkway, Gaithersburg, MD, USA
| | - Ashley L Wilson
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Priyanka Ahimaz
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Catherine Au
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Sara M Berger
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Edwin Guzman
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Michelle Primiano
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Jessica E Shaw
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Meredith Ross
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Leyla Tabanfar
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Ilana Chilton
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily Griffin
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Chana Ratner
- Long Island University, LIU Post Genetic Counseling Graduate Program, Brookville, NY, USA
| | - Kwame Anyane-Yeboa
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Iglesias
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Laura Pisani
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Jasmin Roohi
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Jimmy Duong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Josue Martinez
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and NY State Psychiatric Institute, New York, NY, USA
| | - Robert Klitzman
- G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University Irving Medical Center, and NY State Psychiatric Institute, New York, NY, USA
| | - Ruth Ottman
- G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University Irving Medical Center, and NY State Psychiatric Institute, New York, NY, USA
| | - Wendy K Chung
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA; Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Wynn
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
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26
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Effectiveness of the Genomics ADvISER decision aid for the selection of secondary findings from genomic sequencing: a randomized clinical trial. Genet Med 2019; 22:727-735. [PMID: 31822848 DOI: 10.1038/s41436-019-0702-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of the Genomics ADvISER (www.genomicsadviser.com) decision aid (DA) for selection of secondary findings (SF), compared with genetic counseling alone. METHODS A randomized controlled trial (RCT) was conducted to evaluate whether the Genomics ADvISER is superior to genetic counseling when hypothetically selecting SF. Participants were randomized to use the DA followed by discussion with a genetic counselor, or to genetic counseling alone. Surveys were administered at baseline and post-intervention. Primary outcome was decisional conflict. Secondary outcomes were knowledge, preparation for, and satisfaction with decision-making, anxiety, and length of counseling session. RESULTS Participants (n = 133) were predominantly White/European (74%), female (90%), and ≥50 years old (60%). Decisional conflict (mean difference 0.05; P = 0.60), preparation for decision-making (0.17; P = 0.95), satisfaction with decision (-2.18; P = 0.06), anxiety (0.72; P = 0.56), and knowledge of sequencing limitations (0.14; P = 0.70) did not significantly differ between groups. However, intervention participants had significantly higher knowledge of SF (0.39; P < 0.001) and sequencing benefits (0.97; P = 0.01), and significantly shorter counseling time (24.40 minutes less; P < 0.001) CONCLUSIONS: The Genomics ADvISER did not decrease decisional conflict but reduced counseling time and improved knowledge. This decision aid could serve as an educational tool, reducing in-clinic time and potentially health care costs.
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27
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Read P, Yashar BM, Robinson L, Marvin M. Optimizing efficiency and skill utilization: Analysis of genetic counselors' attitudes regarding delegation in a clinical setting. J Genet Couns 2019; 29:67-77. [DOI: 10.1002/jgc4.1181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Parker Read
- Simmons Comprehensive Cancer Center UT Southwestern Medical Center Dallas TX USA
| | - Beverly M. Yashar
- Department of Human Genetics University of Michigan Ann Arbor MI USA
| | - Linda Robinson
- Simmons Comprehensive Cancer Center UT Southwestern Medical Center Dallas TX USA
| | - Monica Marvin
- Department of Human Genetics University of Michigan Ann Arbor MI USA
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28
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Lewis C, Loe BS, Sidey-Gibbons C, Patch C, Chitty LS, Sanderson SC. Development of a measure of genome sequencing knowledge for young people: The kids-KOGS. Clin Genet 2019; 96:411-417. [PMID: 31323115 PMCID: PMC6851564 DOI: 10.1111/cge.13607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
Genome sequencing (GS) is increasingly being used to diagnose rare diseases in paediatric patients; however, no measures exist to evaluate their knowledge of this technology. We aimed to develop a robust measure of knowledge of GS (the kids‐KOGS') suitable for use in the paediatric setting as well as for general public education. The target age was 11 to 15 year olds. An iterative process involving six sequential stages was conducted to develop a set of draft true/false items. These were then administered to 539 target‐age school pupils (mean 12.8; SD ± 1.3), from the United Kingdom. Item‐response theory was used to confirm the psychometric suitability of the candidate items. None of the Items was identified as misfits. All 10 items performed well under the two‐parameter logistic model. The internal consistency of the test was 0.84 (Cronbach alpha value) indicating excellent reliability. The mean kids‐KOGS score in the sample overall was 4.24 (SD; 2.49), where 0 = low knowledge and 10 = high knowledge. Age was positively associated with score in a multivariate linear regression. The kids‐KOGS is a short and reliable tool that can be used by researchers and healthcare professionals offering GS to paediatric patients. Further validation in a clinical setting is required.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Bao S Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - Chris Sidey-Gibbons
- Patient Reported Outcomes, Value and Experience (PROVE) Centre, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Patch
- Genomics England, Queen Mary University of London, London, UK.,Counselling, Society and Ethics Research, Wellcome Genome Campus, Cambridge, UK.,Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Saskia C Sanderson
- North East Thames Regional Genetics Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Institute of Health Informatics, University College London, London, UK
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29
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Personal genomic screening: How best to facilitate preparedness of future clients. Eur J Med Genet 2019; 62:397-404. [DOI: 10.1016/j.ejmg.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 02/23/2019] [Accepted: 05/06/2019] [Indexed: 12/24/2022]
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30
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Galindo-Neto NM, Alexandre ACS, Barros LM, Sá GGDM, Carvalho KMD, Caetano JÁ. Creation and validation of an educational video for deaf people about cardiopulmonary resuscitation. Rev Lat Am Enfermagem 2019; 27:e3130. [PMID: 30916231 PMCID: PMC6432986 DOI: 10.1590/1518-8345.2765.3130] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/13/2018] [Indexed: 01/18/2023] Open
Abstract
Objective: to create and validate an educational video for teaching deaf students about cardiopulmonary resuscitation. Method: methodological study consisting in the creation of an educational video, validation of its content by 22 nurses with expertise in cardiorespiratory arrest, and evaluation by 16 deaf students. For data collection, the following validated instruments were used: the Instrument for Validation of Educational Content used for the validation by nurses and the Assistive Technology Assessment Questionnaire for the evaluation by deaf students. The criterion for validation was concordance higher than 80%, analyzed through the content validation index and binomial test. Results: the final version of the video lasted seven minutes and thirty seconds, covered the steps that should be performed by a lay person to help a victim of cardiorespiratory arrest, presented animations and the narration in the Brazilian sign language. All the items obtained agreement among nurses and of among deaf students equal or superior to 80%. Conclusion: the video was considered to present valid content by the judges and comprehensible content by deaf students. Thus the video represents an inclusive technology for health education of deaf people about cardiopulmonary resuscitation.
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Affiliation(s)
- Nelson Miguel Galindo-Neto
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brazil
| | - Ana Carla Silva Alexandre
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brazil
| | - Lívia Moreira Barros
- Universidade Estadual Vale do Acaraú, Departamento de Enfermagem, Sobral, CE, Brazil
| | - Guilherme Guarino de Moura Sá
- Universidade Federal do Piauí, Programa de Pós-Graduação em Enfermagem, Teresina, PI, Brazil.,Universidade Federal do Piauí, Colégio Técnico de Bom Jesus, Bom Jesus, PI, Brazil
| | - Khelyane Mesquita de Carvalho
- Universidade Federal do Piauí, Programa de Pós-Graduação em Enfermagem, Teresina, PI, Brazil.,Universidade Federal do Piauí, Colégio Técnico de Bom Jesus, Bom Jesus, PI, Brazil
| | - Joselany Áfio Caetano
- Universidade Federal do Ceará, Programa de Pós-Graduação em Enfermagem, Fortaleza, CE, Brazil
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31
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Lewis KL, Facio FM, Berrios CD. Using the diffusion of innovations model to guide participant engagement in the genomics era. J Genet Couns 2019; 28:419-427. [PMID: 30653790 DOI: 10.1002/jgc4.1090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 12/12/2022]
Abstract
Exome and genome sequencing (EGS) are increasingly the genetic testing modalities of choice among researchers owing to their ready availability, low cost, and large data output. Recruitment of larger, more diverse cohorts into long-term studies with extensive data collection is fundamental to the success of EGS research and to the widespread benefit of genomic medicine to various populations. Effective engagement will be critical to meeting this demand. The Diffusion of Innovation (DOI) model provides a framework for how new technologies are adopted in communities, including antecedents of an individual's decision to adopt the technology, how the technology's attributes influence its acceptability, the predictors of sustained use of that technology, and its diffusion through society. We apply the DOI model to frame participant engagement in EGS research and to guide the proposal of potential strategies that aim to overcome forecasted challenges. Finally, we suggest a variety of ways genetic counselors can apply their skills and training to the development and implementation of these strategies.
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Affiliation(s)
- Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Flavia M Facio
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Courtney D Berrios
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
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32
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Sanderson SC, Loe BS, Freeman M, Gabriel C, Stevenson DC, Gibbons C, Chitty L, Lewis C. Development of the Knowledge of Genome Sequencing (KOGS) questionnaire. PATIENT EDUCATION AND COUNSELING 2018; 101:1966-1972. [PMID: 30031711 DOI: 10.1016/j.pec.2018.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Whole-genome sequencing is being implemented in research and clinical care, yet tools to assess patients' knowledge are lacking. Our aim was to develop a robust measure of whole-genome sequencing knowledge suitable for patients and other stakeholders including research participants, public, students, and healthcare professionals. METHODS An initial set of 17 items was developed via an iterative process including literature review, expert consultation, focus groups, and cognitive interviews with patients, and then administered to 243 individuals. We used exploratory factor analysis and item-response theory to confirm the psychometric suitability of the candidate items for assessing whole-genome sequencing knowledge. RESULTS There was a strong main component after removing 5 items with low factor loadings. Item and scale homogeneity was achieved using Mokken scale analysis. Three further items were removed because they were misfits, inverse duplicates or resulted in local dependency. The remaining nine items fitted the two-parameter logistic IRT model which achieved excellent fit to the observed data. Cronbach's alpha was 0.79 indicating acceptable reliability. CONCLUSION The KOGS, developed using a rigorous psychometric approach, is a brief and reliable tool. PRACTICE IMPLICATIONS The KOGS may prove useful for researchers and healthcare professionals using whole-genome sequencing with patients and other stakeholders.
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Affiliation(s)
- Saskia C Sanderson
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK; Department of Behavioural Science and Health, University College London, London, UK.
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - Maddie Freeman
- Department of Behavioural Science and Health, University College London, London, UK
| | - Camila Gabriel
- Center for Bioethics, Harvard Medical School, Boston, USA
| | - Danielle C Stevenson
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK
| | - Chris Gibbons
- Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, USA; Department of Surgery, Harvard Medical School, Boston, USA
| | - Lyn Chitty
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK
| | - Celine Lewis
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK
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33
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Increasing genomic literacy among adolescents. Genet Med 2018; 21:994-1000. [PMID: 30214064 DOI: 10.1038/s41436-018-0275-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Adolescents increasingly need to be "genomics literate," and may engage more with video educational formats than traditional written formats. We conducted a pilot study to assess and compare the impact of two modes of education about genome sequencing (GS) on adolescents' genomic knowledge and genomic-related decisions. METHODS Using an online survey, 43 adolescents ages 14-17 years were randomly assigned to watch a video or read a pamphlet about GS. Measures included pre- and postintervention assessment of genomic knowledge, perceived utility of these materials for decisions about participating in genetic research, interest in receiving GS results, and overall satisfaction with these materials. Analyses described results for all participants and compared results between intervention groups. RESULTS Self-reported genomic knowledge increased overall (p < 0.001). Postintervention knowledge about GS limitations was higher among video group than pamphlet group participants (p = 0.038). More video group than pamphlet group participants expressed satisfaction with the material's understandability (45% vs. 29%) and suitability (91% vs. 76%). Interest in receiving personal GS results was significantly associated with being female (p = 0.01) and younger (14-15 years vs. 16-17 years) (p = 0.002). CONCLUSION A video format may be preferable for increasing genomic literacy among adolescents. Further research with adolescents is needed to better understand how gender and age may impact genomic decisions and preferences.
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34
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Evaluation of Recipients of Positive and Negative Secondary Findings Evaluations in a Hybrid CLIA-Research Sequencing Pilot. Am J Hum Genet 2018; 103:358-366. [PMID: 30122538 DOI: 10.1016/j.ajhg.2018.07.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/24/2018] [Indexed: 01/04/2023] Open
Abstract
While consensus regarding the return of secondary genomic findings in the clinical setting has been reached, debate about such findings in the research setting remains. We developed a hybrid, research-clinical translational genomics process for research exome data coupled with a CLIA-validated secondary findings analysis. Eleven intramural investigators from ten institutes at the National Institutes of Health piloted this process. Nearly 1,200 individuals were sequenced and 14 secondary findings were identified in 18 participants. Positive secondary findings were returned by a genetic counselor following a standardized protocol, including referrals for specialty follow-up care for the secondary finding local to the participants. Interviews were undertaken with 13 participants 4 months after receipt of a positive report. These participants reported minimal psychologic distress within a process to assimilate their results. Of the 13, 9 reported accessing the recommended health care services. A sample of 107 participants who received a negative findings report were surveyed 4 months after receiving it. They demonstrated good understanding of the negative secondary findings result and most expressed reassurance (64%) from that report. However, a notable minority (up to 17%) expressed confusion regarding the distinction of primary from secondary findings. This pilot shows it is feasible to couple CLIA-compliant secondary findings to research sequencing with minimal harms. Participants managed the surprise of a secondary finding with most following recommended follow up, yet some with negative findings conflated secondary and primary findings. Additional work is needed to understand barriers to follow-up care and help participants distinguish secondary from primary findings.
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The Patient in Precision Medicine: A Systematic Review Examining Evaluations of Patient-Facing Materials. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9541621. [PMID: 30250657 PMCID: PMC6140003 DOI: 10.1155/2018/9541621] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Precision medicine (PM) has the potential to tailor healthcare to the individual patient by using their genetic information to guide treatment choices. However, this process is complex and difficult to understand for patients and providers alike. With a recent push in the healthcare community to understand the patient experience and engage patients in their care, it is important to give patients the opportunity to learn about PM. We performed a systematic review to identify previous work assessing the quality of patient-facing PM materials from 2008 to July 2018. Ten studies were identified, which used varying methods and measures. A qualitative assessment was conducted to compare key elements of the studies, including study design, characteristics of the participant population, what measurements were used to assess the PM materials, understandability, preference, psychological reactions, and the type of PM materials being assessed. The studies identified provide important groundwork by highlighting consistent aspects of design that aid in comprehension. Eight of the ten studies focused on the content and organization of genomic test results, while the remaining two assessed educational tools. Two main design elements that appeared across the studies were appropriately designed visual aids and simplified language. The studies identified were limited by the participant populations that were used, which were primarily white and well educated. Only one study attempted to oversample patient populations typically underrepresented in this type of research. Through our systematic review, it is evident that the breadth of knowledge in this field is limited in scope and that more work must be done to ensure that patients can engage in their care when faced with PM.
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Bombard Y, Clausen M, Mighton C, Carlsson L, Casalino S, Glogowski E, Schrader K, Evans M, Scheer A, Baxter N, Hamilton JG, Lerner-Ellis J, Offit K, Robson M, Laupacis A. The Genomics ADvISER: development and usability testing of a decision aid for the selection of incidental sequencing results. Eur J Hum Genet 2018; 26:984-995. [PMID: 29703952 PMCID: PMC6018661 DOI: 10.1038/s41431-018-0144-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023] Open
Abstract
Guidelines recommend patients be informed of their incidental results (IR) when undergoing genomic sequencing (GS), yet there are limited tools to support patients' decisions about learning IR. The aim of this study is to develop and test the usability of a decision aid (DA) to guide patients' selection of IR, and to describe patients' preferences for learning IR following use of the DA. We developed and evaluated a DA using an iterative, mixed-methods process consisting of (1) prototype development, (2) feasibility testing, (3) cognitive interviews, (4) design and programming, and (5) usability testing. We created an interactive online DA called the Genomics ADvISER, a genomics decision AiD about Incidental SEquencing Results. The Genomics ADvISER begins with an educational whiteboard video, and then engages users in a values clarification exercise, knowledge quiz and final choice step, based on a 'binning' framework. Participants found the DA acceptable and intuitive to use. They were enthusiastic towards GS and IR; all selected multiple categories of IR. The Genomics ADvISER is a new patient-centered tool to support the clinical delivery of incidental GS results. The Genomics ADvISER fills critical care gaps, given the health care system's limited genomics expertise and capacity to convey the large volume of IR and their myriad of implications.
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Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - Marc Clausen
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | - Selina Casalino
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | | | - Michael Evans
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Adena Scheer
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nancy Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Cancer Care Ontario, Toronto, ON, Canada
| | | | - Jordan Lerner-Ellis
- Mount Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Laupacis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
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Winston K, Grendarova P, Rabi D. Video-based patient decision aids: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:558-578. [PMID: 29102063 DOI: 10.1016/j.pec.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends. METHOD The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted. RESULTS 488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase. CONCLUSION Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations. PRACTICE IMPLICATIONS Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.
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Affiliation(s)
- Karin Winston
- Alberta Children's Hospital, 2800 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - Petra Grendarova
- University of Calgary, Division of Radiation Oncology, Calgary, Canada
| | - Doreen Rabi
- University of Calgary, Department of Medicine, Calgary, Canada
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Gordon ES, Babu D, Laney DA. The future is now: Technology's impact on the practice of genetic counseling. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018. [DOI: 10.1002/ajmg.c.31599] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Dawn A. Laney
- Department of Human GeneticsEmory School of MedicineDecatur Georgia
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Staunton C, Tindana P, Hendricks M, Moodley K. Rules of engagement: perspectives on stakeholder engagement for genomic biobanking research in South Africa. BMC Med Ethics 2018; 19:13. [PMID: 29482536 PMCID: PMC5828421 DOI: 10.1186/s12910-018-0252-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genomic biobanking research is undergoing exponential growth in Africa raising a host of legal, ethical and social issues. Given the scientific complexity associated with genomics, there is a growing recognition globally of the importance of science translation and community engagement (CE) for this type of research, as it creates the potential to build relationships, increase trust, improve consent processes and empower local communities. Despite this level of recognition, there is a lack of empirical evidence of the practise and processes for effective CE in genomic biobanking in Africa. METHODS To begin to address this vacuum, 17 in-depth face to face interviews were conducted with South African experts in genomic biobanking research and CE to provide insight into the process, benefits and challenges of CE in South Africa. Emerging themes were analysed using a contextualised thematic approach. RESULTS Several themes emerged concerning the conduct of CE in genomic biobanking research in Africa. Although the literature tends to focus on the local community in CE, respondents in this study described three different layers of stakeholder engagement: community level, peer level and high level. Community level engagement includes potential participants, community advisory boards (CAB) and field workers; peer level engagement includes researchers, biobankers and scientists, while high level engagement includes government officials, funders and policy makers. Although education of each stakeholder layer is important, education of the community layer can be most challenging, due to the complexity of the research and educational levels of stakeholders in this layer. CONCLUSION CE is time-consuming and often requires an interdisciplinary research team approach. However careful planning of the engagement strategy, including an understanding of the differing layers of stakeholder engagement, and the specific educational needs at each layer, can help in the development of a relationship based on trust between the research team and various stakeholder groups. Since the community layer often comprises vulnerable populations in low and middle income countries (LMICs), co-development of innovative educational tools on genomic biobanking is essential. CE is clearly a component of a broader process best described as stakeholder engagement.
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Affiliation(s)
- Ciara Staunton
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Melany Hendricks
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Keymanthri Moodley
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Mills R, Ensinger M, Callanan N, Haga SB. Development and Initial Assessment of a Patient Education Video about Pharmacogenetics. J Pers Med 2017; 7:jpm7020004. [PMID: 28587070 PMCID: PMC5491980 DOI: 10.3390/jpm7020004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/19/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
As few patient-friendly resources about pharmacogenetics are currently available, we aimed to create and assess a patient educational video on pharmacogenetic testing. A primary literature and resources review was conducted to inform the content and the format of the video. The educational video was then created using a commercially available animation program and pilot tested in focus groups of the general public and by an online survey of pharmacists. Emerging themes from the focus groups and survey indicate a desire for appropriate risk contextualization and specific examples when pharmacogenetic testing may be beneficial. Focus group participants also expressed a preference for a video with live action, and more text to reinforce concepts. Pharmacists generally felt that the video was understandable for patients and relevant for decision-making regarding testing. Using this initial feedback and the identification of important concepts to include in pharmacogenetics educational tools, we plan to revise the video, perform additional evaluations, and publish the video for public use in the future.
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Affiliation(s)
- Rachel Mills
- Duke University Department of Medicine, Center for Applied Genomics and Precision Medicine, 304 Research Drive, Box 90141, Durham, NC 27710, USA.
| | - Megan Ensinger
- OhioHealth Genetic Counseling Program, Bing Cancer Center, 500 Thomas Ln Ste 2D Columbus, Columbus, OH 43214, USA.
| | - Nancy Callanan
- University of North Carolina, Greensboro School of Health and Human Services, Genetic Counseling Program, 1400 Spring Garden St. Greensboro, Greensboro, NC 27412, USA.
| | - Susanne B Haga
- Duke University Department of Medicine, Center for Applied Genomics and Precision Medicine, 304 Research Drive, Box 90141, Durham, NC 27710, USA.
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Wade CH, Elliott KR. Preferences for the provision of whole genome sequencing services among young adults. PLoS One 2017; 12:e0174131. [PMID: 28334023 PMCID: PMC5363863 DOI: 10.1371/journal.pone.0174131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/01/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives As whole genome sequencing (WGS) becomes increasingly available, clinicians will be faced with conveying complex information to individuals at different stages in life. The purpose of this study is to characterize the views of young adults toward obtaining WGS, learning different types of genomic information, and having choice about which results are disclosed. Methods A mixed-methods descriptive study was conducted with a diverse group of 18 and 19-years-olds (N = 145). Participants watched an informational video about WGS and then completed an online survey. Results Participants held a positive attitude toward obtaining WGS and learning about a range of health conditions and traits. Increased interest in learning WGS information was significantly associated with anticipated capacity to handle the emotional consequences if a serious risk was found (β = 0.13, P = .04). Young adults wanted the ability to choose what types of genomic risk information would be returned and expressed decreased willingness to undergo WGS if clinicians made these decisions (t(138) = -7.14, P <.01). Qualitative analysis showed that young adults emphasized procedural factors in WGS decision-making and that perceived health benefits of WGS had a substantial role in testing preferences and anticipated usage of WGS results. Conclusions Clinicians are likely to encounter enthusiasm for obtaining WGS results among young adults and may need to develop strategies for ensuring that this preference is adequately informed.
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Affiliation(s)
- Christopher H. Wade
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, Washington, United States of America
- * E-mail:
| | - Kailyn R. Elliott
- School of Medicine, University of Washington, Seattle, Washington, United States of America
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Informed consent for next-generation nucleotide sequencing studies: Aiding communication between participants and investigators. J Clin Transl Sci 2017. [PMID: 28649453 PMCID: PMC5471895 DOI: 10.1017/cts.2016.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Obtaining informed consent from prospective participants for research studies that include next-generation nucleotide sequencing (NGS) presents significant challenges because of the need to explain all the potential implications of participating, including the possible return of "incidental" findings, in easy-to-understand language. METHODS AND RESULTS After reviewing the consent processes at other institutions, we decided to supplement the protocol-specific informed consent form with the following: (1) a short pamphlet for the prospective participant that includes a series of questions that she or he is encouraged to ask the investigator, and (2) a more detailed companion guide for investigators to help them develop simple-language answers to the questions. Both documents are available to use or modify. CONCLUSIONS We propose an approach to obtaining informed consent for NGS studies that encourages discussion of key issues without creating a complex, comprehensive document for participants; it also maximizes investigator flexibility. We also suggest mechanisms to return restricted information to participants.
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Research Participants’ Preferences for Hypothetical Secondary Results from Genomic Research. J Genet Couns 2016; 26:841-851. [DOI: 10.1007/s10897-016-0059-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Abstract
AIM To characterize the views of young adults toward integrating whole-genome sequencing (WGS) into standard pediatric care, particularly when used as a supplement to newborn screening. MATERIALS & METHODS This mixed methods descriptive study assessed the perspectives of a diverse group of 18- and 19-year olds (n = 145) in the USA using an informational video and online survey. RESULTS Young adults typically recommended disclosing WGS results to both parents and children during childhood. In the qualitative analysis, most participants emphasized the anticipated health benefits of pediatric WGS, while a minority discussed possible negative emotional and developmental impacts. CONCLUSION Differing preferences for pediatric WGS emphasize the importance that clinicians adopt responsive approaches when providing WGS and disclosing results to families.
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Affiliation(s)
- Christopher H Wade
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, WA, USA
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Nadkarni GN, Horowitz CR. Genomics in CKD: Is This the Path Forward? Adv Chronic Kidney Dis 2016; 23:120-4. [PMID: 26979150 DOI: 10.1053/j.ackd.2016.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 01/13/2023]
Abstract
Recent advances in genomics and sequencing technology have led to a better understanding of genetic risk in CKD. Genetics could account in part for racial differences in treatment response for medications including antihypertensives and immunosuppressive medications due to its correlation with ancestry. However, there is still a substantial lag between generation of this knowledge and its adoption in routine clinical care. This review summarizes the recent advances in genomics and CKD, discusses potential reasons for its underutilization, and highlights potential avenues for application of genomic information to improve clinical care and outcomes in this particularly vulnerable population.
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Suckiel SA, Linderman MD, Sanderson SC, Diaz GA, Wasserstein M, Kasarskis A, Schadt EE, Zinberg RE. Impact of Genomic Counseling on Informed Decision-Making among ostensibly Healthy Individuals Seeking Personal Genome Sequencing: the HealthSeq Project. J Genet Couns 2016; 25:1044-53. [PMID: 26898680 DOI: 10.1007/s10897-016-9935-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/03/2016] [Indexed: 01/27/2023]
Abstract
Personal genome sequencing is increasingly utilized by healthy individuals for predispositional screening and other applications. However, little is known about the impact of 'genomic counseling' on informed decision-making in this context. Our primary aim was to compare measures of participants' informed decision-making before and after genomic counseling in the HealthSeq project, a longitudinal cohort study of individuals receiving personal results from whole genome sequencing (WGS). Our secondary aims were to assess the impact of the counseling on WGS knowledge and concerns, and to explore participants' satisfaction with the counseling. Questionnaires were administered to participants (n = 35) before and after their pre-test genomic counseling appointment. Informed decision-making was measured using the Decisional Conflict Scale (DCS) and the Satisfaction with Decision Scale (SDS). DCS scores decreased after genomic counseling (mean: 11.34 before vs. 5.94 after; z = -4.34, p < 0.001, r = 0.52), and SDS scores increased (mean: 27.91 vs. 29.06 respectively; z = 2.91, p = 0.004, r = 0.35). Satisfaction with counseling was high (mean (SD) = 26.91 (2.68), on a scale where 6 = low and 30 = high satisfaction). HealthSeq participants felt that their decision regarding receiving personal results from WGS was more informed after genomic counseling. Further research comparing the impact of different genomic counseling models is needed.
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Affiliation(s)
- Sabrina A Suckiel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA. .,Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Michael D Linderman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA.,Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saskia C Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA.,Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Health Behaviour Research Centre, University College London, London, UK
| | - George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA
| | - Melissa Wasserstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA
| | - Andrew Kasarskis
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA.,Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA.,Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, USA
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