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Faraj W, Robson M, Tawil A, Reuter V, Mahfouz R, Cambria R, Saheb N, Ferrer CS, Vemuri S, Yaghi M, Kanso M, Abdullah A, El Nounou G, Jabbour M, Muenkel K, Kaufman K, Wakim JM, Badson S, Wilson R, Houston C, Drobnjak M, Hoballah J, Ziyadeh FN, Zaatari G, Brennan M, O'Reilly EM, Abu-Alfa AK, Abou-Alfa GK. Biospecimen Repositories in Low- and Middle-Income Countries: Insights From an American University of Beirut and Memorial Sloan Kettering Collaboration. JCO Glob Oncol 2023; 9:e2300140. [PMID: 37883726 PMCID: PMC10846789 DOI: 10.1200/go.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Biobanking helps source tissue and blood for studying cancer genomics. Access to biorepository resources in low- and middle-income countries is lacking. Memorial Sloan Kettering Cancer Center (MSK) and the American University of Beirut (AUB) established a joint tissue biorepository at AUB in Beirut, Lebanon. The undertaking encountered key challenges that were unanticipated. MATERIALS AND METHODS Patients age 18 years or older were eligible for enrollment at AUB. After consent, biospecimens were obtained at the time of routine diagnostic and/or therapeutic interventions. Both normal and abnormal tissue and solid and/or liquid specimens were collected from varied body sites. Early on, declining consent was frequently observed, and this was highlighted for investigation to understand potential participants reasoning. RESULTS Of 850 patients approached, 704 (70.8%) elected to consent and 293 (29.5%) declined participation. The number of declined consents led to an amendment permitting the documentation of reasons for same. Of 100 potential participants who declined to consent and to whom outreach was undertaken, 63% indicated lack of research awareness and 27% deferral to their primary physician or family member. A financial gain for AUB was cited as concern by 5%, cultural boundaries in 4%, and 1% expressed concern about confidentiality. Of the patients who elected to consent, 682 biospecimens were procured. CONCLUSION The AUB-MSK biospecimen repository has provided a unique resource for interrogation. Patient participation rate was high, and analyses of those who elected not to consent (29%) provide important insights into educational need and the local and cultural awareness and norms.
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Affiliation(s)
- Walid Faraj
- American University of Beirut, Beirut, Lebanon
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Ayman Tawil
- American University of Beirut, Beirut, Lebanon
| | - Victor Reuter
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Roy Cambria
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nour Saheb
- American University of Beirut, Beirut, Lebanon
| | | | - Shreya Vemuri
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Mark Jabbour
- American University of Beirut, Beirut, Lebanon
- Deceased
| | - Kerri Muenkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sandy Badson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roger Wilson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Deceased
| | | | | | | | | | | | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Saylor KW, Klein WM, Calancie L, Lewis KL, Biesecker LG, Turbitt E, Roberts MC. Genetic Testing and Other Healthcare Use by Black and White Individuals in a Genomic Sequencing Study. Public Health Genomics 2023; 26:90-102. [PMID: 37544304 PMCID: PMC10614486 DOI: 10.1159/000533356] [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: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aimed to understand the association between self-identified race and individual experience with genetic testing outside of the research context. METHODS We assessed factors associated with the odds of having ever received genetic testing prior to enrollment in a genomic sequencing study among 674 self-identified white and 407 self-identified African, African American, or Afro-Caribbean ("Black") individuals. RESULTS Controlling for individual determinants of healthcare use (demographics, personality traits, knowledge and attitudes, and health status), identifying as Black was associated with lower odds of prior genetic testing (OR = 0.43, 95% CI [0.27-0.68], p < 0.001). In contrast, self-identified race was not associated with the use of non-genetic clinical screening tests (e.g., echocardiogram, colonoscopy). Black and white individuals were similar on self-reported personality traits tied to early adoption but differed by sociodemographic and resource facilitators of early adoption. CONCLUSION Persistent racial disparities among early adopters may represent especially-entrenched disparities in access to and knowledge of genomic technologies in clinical settings.
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Affiliation(s)
- Katherine W. Saylor
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William M.P. Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Katie L. Lewis
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leslie G. Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan C. Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Kaphingst KA, Bather JR, Daly BM, Chavez-Yenter D, Vega A, Kohlmann WK. Interest in Cancer Predisposition Testing and Carrier Screening Offered as Part of Routine Healthcare Among an Ethnically Diverse Sample of Young Women. Front Genet 2022; 13:866062. [PMID: 35495140 PMCID: PMC9047995 DOI: 10.3389/fgene.2022.866062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
Sequencing technologies can inform individuals’ risks for multiple conditions, supporting population-level screening approaches. Prior research examining interest in genetic testing has not generally examined the context of population-based approaches offered in routine healthcare or among ethnically diverse populations. Cancer predisposition testing and carrier screening could be offered broadly to women of reproductive age. This study therefore examined interest in these tests when offered as part of routine care, and predictors of interest, among an ethnically diverse sample of women aged 20–35. We conducted an online English-language survey of 450 women; 39% identified as Latina. We examined predictors of interest for two outcomes, interest in testing in the next year and level of interest, in multivariable logistic regression models and stratified analyses by Latina ethnicity. More than half of respondents reported being interested in cancer predisposition testing (55%) and carrier screening (56%) in the next year; this did not differ by ethnicity. About 26% reported being very interested in cancer predisposition testing and 27% in carrier screening. Latina respondents (32%) were more likely to be very interested in cancer predisposition testing than non-Latina respondents (22%; p < 0.03). In multivariable models, having higher worry about genetic risks, higher genetic knowledge, and higher perceived importance of genetic information were associated with higher interest across multiple models. Predictors of interest were generally similar by ethnicity. Our findings show substantial interest in both cancer predisposition testing and carrier screening among young women as part of routine healthcare with similar interest between Latina and non-Latina women. Efforts to broadly offer such testing could be important in improving access to genetic information. It will be critical to develop tools to help healthcare providers communicate about genetic testing and to address the needs of those who have less prior knowledge about genetics to support informed decision making.
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Affiliation(s)
- Kimberly A. Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Kimberly A. Kaphingst,
| | - Jemar R. Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Alexis Vega
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Wendy K. Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
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Peterson EB, Taber JM, Klein WMP. Information Avoidance, Self-affirmation, and Intentions to Receive Genomic Sequencing Results Among Members of an African Descent Cohort. Ann Behav Med 2021; 56:205-211. [PMID: 34089040 DOI: 10.1093/abm/kaab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information avoidance tendencies have been found to be associated with lower intentions to pursue medically actionable genomic sequencing results, but less so among individuals who engage more in spontaneous self-affirmation. Yet these results were obtained with a largely non-Hispanic White, high-SES cohort. PURPOSE To assess these variables, their magnitude, and their associations in an African-descent cohort as part of the same ClinSeq® exome sequencing program. METHODS Participants reported levels of spontaneous self-affirmation, information avoidance, and intentions to receive three types of results - medically actionable, non-medically actionable, and carrier status as part of a baseline survey. RESULTS Relative to the original, non-Hispanic White cohort, those in the African-descent cohort had higher levels of spontaneous self-affirmation and lower intentions of learning about carrier genomic results; they reported comparable levels of information avoidance and intentions to receive other results. Information avoidance was negatively associated with intention to receive non-actionable results in the African-descent cohort, as found in the initial cohort, with no moderating effect of spontaneous self-affirmation. Information avoidance, spontaneous self-affirmation, and their interaction were not associated with intentions to receive actionable results (contrary to findings in the initial cohort), or carrier results. CONCLUSIONS Individuals of African descent may engage in relatively more spontaneous self-affirmation, and do not appear to engage in more information avoidance. Their information avoidance tendencies were associated with pursuit of non-actionable sequencing results, with no moderating effect of self-affirmation, and were not associated with pursuit of actionable results or carrier results.
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Affiliation(s)
- Emily B Peterson
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA.,National Human Genome Research Institute, Bethesda, MD, USA
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Hendricks-Sturrup RM, Edgar LM, Johnson-Glover T, Lu CY. Exploring African American community perspectives about genomic medicine research: A literature review. SAGE Open Med 2020; 8:2050312120901740. [PMID: 32064110 PMCID: PMC6993150 DOI: 10.1177/2050312120901740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022] Open
Abstract
Genomic medicine research is an important topic in the African American health care community. African American nurses and advance practice nursing professionals are poised to encourage and educate themselves and their communities about the importance of diversity in genomic medicine research. The Southern Nevada Black Nurses Association, a chapter within the larger National Black Nurses Association’s, recently engaged in the National Institutes of Health All of Us research program to educate their members about formularies and other treatment modalities that could clinically benefit African-Americans and other populations of color. During this event, the Southern Nevada Black Nurses Association discovered that National Black Nurses Association members held ethical, legal, and social concerns about engaging in genomic medicine research that align with respective concerns reported in the literature. In this review, we discuss National Black Nurses Association concerns and how they relate to qualitative themes emerging from the literature and a recent National Academies of Science, Engineering, and Medicine event on disparities in access to genomic medicine. We conclude that researchers should engage with African American health community leaders to effectively engage the African American community in genomic medicine research and help ensure that genomic medicine does not exacerbate existing health disparities.
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Affiliation(s)
- Rachele M Hendricks-Sturrup
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lauren M Edgar
- Southern Nevada Black Nurses Association, Las Vegas, NV, USA
| | - Tracey Johnson-Glover
- Southern Nevada Black Nurses Association, Las Vegas, NV, USA.,School of Nursing, Touro University, Henderson, NV, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
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