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Ketchum FB, Chin NA, Erickson C, Lambrou NH, Basche K, Gleason CE, Clark L. The importance of the dyad: Participant perspectives on sharing biomarker results in Alzheimer's disease research. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12416. [PMID: 37583545 PMCID: PMC10423755 DOI: 10.1002/trc2.12416] [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] [Received: 01/23/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND In the asymptomatic "preclinical" phase of Alzheimer's disease (AD), abnormal biomarkers indicate risk for developing cognitive impairment. Biomarker information is increasingly being disclosed to participants in research settings, and biomarker testing and results disclosure will be implemented in clinical settings in the future. Biomarker disclosure has potential psychosocial benefits and harms, impacting affected individuals and their support person(s). Limited data are available about with whom research participants share their results, information that will be necessary to develop disclosure protocols and post-disclosure resources. Additionally, existing research has been conducted in largely White cohorts, limiting applicability to future clinical populations. METHODS We enrolled a diverse cohort of 329 adults (184 non-Hispanic White and 145 Black/African American individuals) who previously participated in AD research. After reviewing a vignette describing a hypothetical biomarker research study, participants indicated their anticipated willingness to share biomarker results with loved ones, and what reactions they anticipated from others. Using mixed-methods analysis, we identified responses related to willingness to share results. RESULTS A majority (78.7%) were willing to share their results with support persons. Many (59.6%) felt it would not be difficult to share, and most (90.6%) believed their loved ones would be supportive. The most common reasons for sharing were to prepare for possible future AD (41.0% of respondents), while the most common reason for not sharing was to avoid worrying loved ones (4.8% of respondents). A total of 7.3% of respondents related reasons regarding being unsure about sharing. DISCUSSION Participants' interest in sharing results supports integrating support persons into AD biomarker research, and may help maximize potential benefits for participants. Communicating with this "dyad" of research participant and support person(s) may improve involvement in research, and help prepare for implementation of clinical biomarker testing by clarifying communication preferences and the influence of support persons on psychosocial outcomes.
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Affiliation(s)
- Fred B. Ketchum
- Department of NeurologySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Claire Erickson
- Department of Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Nickolas H. Lambrou
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kristin Basche
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Carey E. Gleason
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Lindsay Clark
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies. J Pain Symptom Manage 2023; 65:e29-e50. [PMID: 36198334 PMCID: PMC9790041 DOI: 10.1016/j.jpainsymman.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers. OBJECTIVES To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers. METHODS A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study. RESULTS 36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored. CONCLUSION HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.
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Affiliation(s)
- Bethany Faith Leidl
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina
| | | | - Francis O Walker
- Department of Neurology, Emeritus, Winston-Salem, (F.O.W.) North Carolina, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina
| | - Buddy Marterre
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina; Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina; Department of General Surgery, (B.M.) Winston-Salem, North Carolina.
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Ketchum FB, Chin NA, Grill J, Gleason CE, Erickson C, Clark LR, Paulsen JS, Kind AJ. Moving beyond disclosure: Stages of care in preclinical Alzheimer's disease biomarker testing. Alzheimers Dement 2022; 18:1969-1979. [PMID: 35213786 PMCID: PMC9402800 DOI: 10.1002/alz.12620] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/28/2023]
Abstract
Alzheimer's disease (AD) begins with an asymptomatic "preclinical" phase, in which abnormal biomarkers indicate risk for developing cognitive impairment. Biomarker information is increasingly being disclosed in research settings, and is moving toward clinical settings with the development of cheaper and non-invasive testing. Limited research has focused on the safety and psychological effects of disclosing biomarker results to cognitively unimpaired adults. However, less is known about how to ensure equitable access and robust counseling for decision-making before testing, and how to effectively provide long-term follow-up and risk management after testing. Using the framework of Huntington's disease, which is based on extensive experience with disclosing and managing risk for a progressive neurodegenerative condition, this article proposes a conceptual model of pre-disclosure, disclosure, and post-disclosure phases for AD biomarker testing. Addressing research questions in each phase will facilitate the transition of biomarker testing into clinical practice.
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Affiliation(s)
- Fred B. Ketchum
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Joshua Grill
- Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA,Departments of Psychiatry and Human Behavior and Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Carey E. Gleason
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA,Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Claire Erickson
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA,Neuroscience & Public Policy ProgramUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Lindsay R. Clark
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jane S. Paulsen
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Amy J.H. Kind
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA,Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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4
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Petzke TM, Rodriguez-Girondo M, van der Meer LB. The Hold me Tight Program for Couples Facing Huntington's Disease. J Huntingtons Dis 2022; 11:203-215. [PMID: 35466944 DOI: 10.3233/jhd-210516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A positive predictive genetic test for Huntington's disease (HD) can be a life-changing event for both carriers and their partners, leading to lower wellbeing and increasing the risk for separation and divorce. The 'Hold me Tight' program (HmT), based on emotionally focused couples' therapy, aims at strengthening the couple bond by targeting attachment needs. OBJECTIVE This study investigates whether the HmT program helps couples strengthen their relationship, as an investment in a future where the disease will affect life in many ways. METHODS In a multiple baseline design using three baselines of varying length, 15 couples of presymptomatic HD-carriers and their partners were included. In three consecutive groups, couples underwent the intervention (an adapted version of the 8-session HmT program) in four weekly sessions and completed self-report questionnaires throughout the study period of 19 weeks (17 measurements). Attachment style was assessed at baseline, resilience at baseline and at the end of the follow-up, while relationship satisfaction and wellbeing were measured weekly. A multi-level model was applied to the data. RESULTS Over the course of the study, wellbeing and relationship satisfaction significantly improved; resilience, however, did not. Furthermore, all three outcome measures were moderated by attachment style, with more securely attached individuals showing better outcomes. CONCLUSION HmT improved wellbeing and relationship satisfaction of couples facing HD. Due to these improvements and high patient acceptability rates, this program could become a standardized procedure in HD care. The program could be adapted for other populations, e.g., couples facing other genetic neurological disorders.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.,Deptartment of Health, Medical, and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Mar Rodriguez-Girondo
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
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Bannon SM, Grunberg VA, Manglani HR, Lester EG, Ritchie C, Vranceanu AM. Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases. J Am Geriatr Soc 2022; 70:1850-1862. [PMID: 35435998 DOI: 10.1111/jgs.17801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurodegenerative diseases (NDDs) are increasingly prevalent and radically alter the lives of individuals and their informal care partners (together called a dyad). As symptoms progress, dyads are at risk for elevated emotional distress and declines in relationship functioning and quality of life. Psychosocial interventions delivered to dyads early after diagnosis have successfully prevented chronic emotional distress across several chronic illnesses including cancer and acute brain injury. Dyads with NDD could benefit from such interventions, however, they are limited. Because NDDs have symptom profiles that are distinct from other chronic illnesses, they require a unique framework and interventions. Given the limited dyadic interventions and unified symptoms across NDDs, a transdiagnostic framework may help to enhance scalability and efficiency. To address this problem, we developed a transdiagnostic framework that cuts across NDD physical and emotional diagnoses to inform cost-effective and sustainable NDD dyadic interventions. METHODS To develop this framework, we conducted: (1) a narrative review on dyadic adjustment and existent dyadic interventions for those with NDDs, and (2) integrated findings to develop our NDD transdiagnostic framework for dyadic interventions early after diagnosis. RESULTS Findings revealed no existent dyadic interventions for NDDs delivered shortly after diagnosis. Among available interventions, all were delivered later in disease progression, thereby focusing on dyadic challenges at more advanced stages. In addition, although research emphasized the influence of individual, dyadic, and contextual factors on dyads' early adjustment to NDDs, no conceptual model has been developed. Informed by theory and current research, we introduce an NDD transdiagnostic framework for couples' early biopsychosocial adjustment. This framework includes NDD specific: contextual factors, illness-related factors, individual and dyadic stressors, adaptive coping strategies, and dyads' resources. CONCLUSIONS Our NDD transdiagnostic framework can be used to inform early dyadic psychosocial interventions that cut across all NDDs. This approach has important implications for implementation and scalability.
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Affiliation(s)
- Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heena R Manglani
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ethan G Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Ritchie
- Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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6
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Davies E, Craufurd D, MacLeod R. "It's being part of the big picture, even though you're a tiny jigsaw piece"-motivations and expectations of individuals participating in the Enroll-HD observational study. J Community Genet 2020; 11:421-432. [PMID: 32157658 PMCID: PMC7475145 DOI: 10.1007/s12687-020-00459-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
Predictive test guidelines for Huntington's disease (HD) recommend individuals are offered opportunities to participate in research regardless of test outcome. Consistent with most HD centres of excellence, the Manchester Centre for Genomic Medicine (MCGM) invites eligible individuals to participate in the observational study, Enroll-HD. Limited research has been conducted to date on the views of research participants and the possible impact of participation. The aim of this qualitative study was to explore the experiences of ten individuals taking part in the Enroll-HD study following pre-symptomatic testing for HD. Half of the individuals had tested positive for the HD mutation and the other half had tested negative. Participants were generally motivated to take part in the study by both personal and altruistic reasons. Overall, they were very positive about participation in Enroll-HD. Valuable aspects included good relationships with the research/clinical team, increased understanding of the condition, an enhanced self-image and a shared experience with affected parents. Issues for improvement to encourage participation included access to study site and more regular communication about study progress. Participants, while generally optimistic about research progress, were realistic about challenges.
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Affiliation(s)
- E Davies
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.
- Department of Clinical Genetics, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
| | - D Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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7
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Bartoszek A, Aubeeluck A, Stupple E, Bartoszek A, Kocka K, Ślusarska B. Exploring the Reliability and Validity of the Huntington's Disease Quality of Life Battery for Carers (HDQoL-C) within A Polish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132323. [PMID: 31262100 PMCID: PMC6651847 DOI: 10.3390/ijerph16132323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022]
Abstract
Huntington’s disease (HD) is a rare genetic neurodegenerative disorder that causes motor disorders, neuropsychiatric symptoms and a progressing deterioration of cognitive functions. Complex issues resulting from the hereditary nature of HD, the complexity of symptoms and the concealed onset of the disease have a great impact on the quality of life of family carers. The caregivers are called the “forgotten people” in HD, especially with relation to genetic counseling. This study aims to explore the reliability and validity of the Huntington’s Disease Quality of Life Battery for carers (HDQoL-C) within a Polish population. A total of 90 carers recruited from the Enroll-HD study in Polish research centers of the European Huntington’s Disease Network completed a polish translation of the HDQoL-C. Data were subjected to Principle Components Analysis (PCA) and reliability measures. The Polish version of the shortened versions of the HDQoL-C is similarly valid compared to the original English version and suitable for use within this population. The HDQoL-C has previously demonstrated a wide range of benefits for practitioners in capturing and understanding carer experience and these benefits can now be extended to Polish speaking populations.
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Affiliation(s)
- Agnieszka Bartoszek
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland.
| | - Aimee Aubeeluck
- School of Health Science, Royal Derby Hospital, University of Nottingham, Nottingham NG7 2RD, UK
| | - Edward Stupple
- Division of Psychology, University of Derby, Derby DE22 1GB, UK
| | - Adrian Bartoszek
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, 90-419 Lodz, Poland
| | - Katarzyna Kocka
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland
| | - Barbara Ślusarska
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland
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Nance MA. Genetic counseling and testing for Huntington's disease: A historical review. Am J Med Genet B Neuropsychiatr Genet 2017; 174:75-92. [PMID: 27174011 DOI: 10.1002/ajmg.b.32453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 12/26/2022]
Abstract
This manuscript describes the ways in which genetic counseling has evolved since John Pearson and Sheldon Reed first promoted "a genetic education" in the 1950s as a voluntary, non-directive clinical tool for permitting individual decision making. It reviews how the emergence of Huntington's disease (HD) registries and patient support organizations, genetic testing, and the discovery of a disease-causing CAG repeat expansion changed the contours of genetic counseling for families with HD. It also reviews the guidelines, outcomes, ethical and laboratory challenges, and uptake of predictive, prenatal, and preimplantation testing, and it casts a vision for how clinicians can better make use of genetic counseling to reach a broader pool of families that may be affected by HD and to ensure that genetic counseling is associated with the best levels of care. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Martha A Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota.,Hennepin County Medical Center, Minneapolis, Minnesota
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Griffith R, Davies K, Lavender V. The characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults. Int J Palliat Nurs 2015; 21:527-33. [PMID: 26619236 DOI: 10.12968/ijpn.2015.21.11.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports a systematic review of literature undertaken to identify characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults with life-limiting or life-threatening conditions. A comprehensive literature search was conducted using the key words 'anticipatory', 'mourning', 'grief', and synonyms. This review focused on six studies that met inclusion criteria and reported characteristics of anticipatory mourning in caregivers of teenagers and young adults. Characteristics and experiences were sorted into four main themes: symptoms; a sense of loss; caregiver behaviour; and the unique experience of caring for, or losing, a teenager or young adult. The review suggests that there are characteristics and experiences of anticipatory mourning that are unique to caregivers of this age group. The review also suggests that consideration of anticipatory mourning is important in offering holistic care to young adults and their caregivers, and points to the need for further research in this area.
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Affiliation(s)
| | - Kerry Davies
- Research Co-ordinator, at Helen and Douglas House Hospice, Oxford
| | - Verna Lavender
- Senior Lecturer in Cancer Care, Faculty of Health and Life Sciences, Oxford Brookes University
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Longitudinal interviews of couples diagnosed with diminished ovarian reserve undergoing fragile X premutation testing. J Genet Couns 2013; 23:97-107. [PMID: 23764957 DOI: 10.1007/s10897-013-9616-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 05/28/2013] [Indexed: 12/19/2022]
Abstract
About 10 % of infertile/subfertile women are diagnosed with diminished ovarian reserve (DOR), of which < 5 % will become pregnant spontaneously. Fragile X (FMR1) genetic testing may provide a reason for her early ovarian aging and/or have reproductive implications. Seven women with DOR (genetic study subset) and the male partners of six of these women were separately interviewed about the experience of being asked to undergo this unanticipated genetic test. Three interviews were conducted (before, within 1 week after, and 3 months after learning the test results). None of the participants carried the FMR1 premutation (largest FMR1 allele 27-50 CGG repeats). For women, their pregnancy-seeking journey was long and exhausting. Women understood the reproductive implications of carrying the FMR1 premutation, and hoped for a negative result. Being offered a genetic test caused women to pause and re-think their future reproductive plans. Husbands viewed the infertility journey as filled with unknowns, of which the genetic test results would be one more puzzle piece. The expense of fertility testing/treatment was mentioned by both spouses, though more notably by husbands. The introduction of a possible genetic cause of infertility, with additional potential health consequences for future biological children, caused women to re-think their quest for pregnancy. In contrast, the genetic test was viewed as an additional source of information for their husbands as opposed to raising concern regarding potential reproductive ramifications.
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Tanaka K, Sekijima Y, Yoshida K, Mizuuchi A, Yamashita H, Tamai M, Ikeda SI, Fukushima Y. [Current status of the predictive genetic testing for hereditary neurological diseases in Shinshu University Hospital]. Rinsho Shinkeigaku 2013; 53:196-204. [PMID: 23524599 DOI: 10.5692/clinicalneurol.53.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The current status of predictive genetic testing for late-onset hereditary neurological diseases in Japan is largely unknown. In this study, we analyzed data from 73 clients who visited the Division of Clinical and Molecular Genetics, Shinshu University Hospital, for the purpose of predictive genetic testing. The clients consisted of individuals with family histories of familial amyloid polyneuropathy (FAP; n=30), Huntington's disease (HD; n=16), spinocerebellar degeneration (SCD; n=14), myotonic dystrophy type 1 (DM1; n=9), familial amyotrophic lateral sclerosis type 1 (ALS1; n=3), and Alzheimer's disease (AD; n=1). Forty-nine of the 73 (67.1%) clients were in their twenties or thirties. Twenty-seven of the 73 (37.0%) clients visited a medical institution within 3 months after becoming aware of predictive genetic testing. The most common reason for requesting predictive genetic testing was a need for certainty or to reduce uncertainty and anxiety. The decision-making about marriage and having a child was also a main reason in clients in the twenties and thirties. The numbers of clients who actually underwent predictive genetic testing was 22 of 30 (73.3%) in FAP, 3 of 16 (18.8%) in HD, 6 of 10 (60.0%) in SCD, 7 of 9 (77.8%) in DM1, and 0 of 3 (0%) in ALS1 (responsible gene of the disease was unknown in 4 SCD patients and an AD patient). The percentage of test usage was lower in untreatable diseases such as HD and SCD than that in FAP, suggesting that many clients changed their way of thinking on the significance of testing through multiple genetic counseling sessions. In addition, it was obvious that existence of disease-modifying therapy promoted usage of predictive genetic testing in FAP. Improvement of genetic counseling system to manage predictive genetic testing is necessary, as consultation concerning predictive genetic testing is the main motivation to visit genetic counseling clinic in many at-risk clients.
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Affiliation(s)
- Keiko Tanaka
- Department of Medical Genetics, Shinshu University School of Medicine
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Andersson PL, Juth N, Petersén Å, Graff C, Edberg AK. Ethical aspects of undergoing a predictive genetic testing for Huntington's disease. Nurs Ethics 2012; 20:189-99. [DOI: 10.1177/0969733012452686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the experiences of undergoing a presymptomatic genetic test for the hereditary and fatal Huntington’s disease, using a case study approach. The study was based on 18 interviews with a young woman and her husband from the decision to undergo the test, to receiving the results and trying to adapt to them, which were analysed using a life history approach. The findings show that the process of undergoing a presymptomatic test involves several closely connected ethical and medical questions, such as the reason for the test, the consequences of the test results and how health-care services can be developed to support people in this situation.
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14
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Lammens CRM, Bleiker EMA, Verhoef S, Ausems MGEM, Majoor-Krakauer D, Sijmons RH, Hes FJ, Gómez-García EB, Van Os TAM, Spruijt L, van der Luijt RB, van den Ouweland AMW, Ruijs MWG, Gundy C, Nagtegaal T, Aaronson NK. Distress in partners of individuals diagnosed with or at high risk of developing tumors due to rare hereditary cancer syndromes. Psychooncology 2011; 20:631-8. [PMID: 21384469 DOI: 10.1002/pon.1951] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 01/21/2011] [Accepted: 01/28/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Li Fraumeni syndrome (LFS) and Von Hippel-Lindau disease (VHL) are two rare hereditary tumor syndromes, characterized by a high risk of developing multiple tumors at various sites and ages for which preventive and treatment options are limited. For partners, it may be difficult to deal with the on-going threat of tumors in both their spouse and children. Therefore, this study aims to evaluate the prevalence of and factors associated with psychological distress among partners of individuals with or at high risk of LFS or VHL. METHODS As part of a nationwide, cross-sectional study, partners of individuals diagnosed with or at high risk of LFS or VHL were invited to complete a self-report questionnaire assessing distress, worries, and health-related quality of life. RESULTS Fifty-five (58%) of those high-risk individuals with a partner consented to having their partner approached for the study. In total, 50 partners (91%) completed the questionnaire, of whom 28% reported clinically relevant levels of syndrome-related distress. Levels of distress and worries of the partners and their high-risk spouse were significantly correlated. Younger age and a lack of social support were also associated significantly with heightened levels of distress and worries. The majority of partners (76%) believed that professional psychosocial support should be routinely offered to them. CONCLUSIONS Approximately one-quarter of the partners exhibit clinically relevant levels of distress that warrant psychological support. The distress levels of the 'patient' could potentially be used to identify partners at risk of developing clinically relevant levels of distress.
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Affiliation(s)
- C R M Lammens
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
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Quintáns B, Prieto Fernández M, Carracedo A, Sobrido M. Genetic counselling in Neurology: A complex problem that requires regulation. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Quintáns B, Prieto MF, Carracedo A, Sobrido MJ. Genetic counselling in neurology: a complex problem that requires regulation. Neurologia 2010; 26:129-36. [PMID: 21163228 DOI: 10.1016/j.nrl.2010.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The generalization of genetic studies is transforming the practice of Neurology and confronts the clinical departments with new challenges, such as the organization of genetic counseling. The requirement of specialized knowledge, both clinical and molecular, as well as the need for psychological evaluation and family support, especially for predictive testing and reproductive planning, makes a multidisciplinary approach mandatory. DEVELOPMENT The main characteristics of genetic neurodegenerative diseases are the high level of required specialization - since these disorders are often rare and of difficult diagnosis - together with a generally progressive course, unavailability of effective treatment, the issues generated by predictive testing and the interpretation of genetic testing. The aim of genetic counseling is to provide sufficient and objective information for each individual to make their own decision on genetic testing. It must touch upon psychological aspects and family communication. The PICOGEN program from the Clinic Hospital in Barcelona for genetic testing and counseling of dementias is a good example of integrated strategy capable of managing this new clinical scenario in neurology. Unfortunately, this program is an exception in Spain and the patients with neurogenetic disorders and their families usually do not have guaranteed access to an appropriate care. CONCLUSIONS Genetic counseling is a unique clinical activity that requires provision of enough time, space and resources to be developed. It implies multidisciplinary participation, due attention to psychological and family issues, and cannot be carried out adequately in a routine Neurology clinic. Legislation is needed to promote a correct articulation of genetic counseling in our country with guarantee of quality and equity. This includes training of the necessary health professionals, clarification of competences and provision of resources to the institutions for the development of such programs.
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Williams JK, Barnette JJ, Reed D, Sousa VD, Schutte DL, McGonigal-Kenney M, Jarmon L, Phillips E, Tripp-Reimer T, Paulsen JS. Development of the Huntington disease family concerns and strategies survey from focus group data. J Nurs Meas 2010; 18:83-99. [PMID: 20806651 DOI: 10.1891/1061-3749.18.2.83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Health concerns and management strategies among families of young and middle-age adults with Huntington's disease (HD) are unknown. This study developed and tested psychometric properties of the Huntington Disease Family Concerns and Strategies Survey (HDFCSS). Focus group data from 91 adult family members were used to develop content. Content analysis yielded four domains that were transferred into Personal, Person With HD, Community Health Care Services, and Strategies scales. Focus group data, expert validation, and cognitive interviews demonstrated survey content validity. Cronbach's alpha internal consistency coefficients for the scales were 0.83 or above. The measure can be used to generate reliable and valid data to identify adult family members' health-related concerns and management strategies for themselves and persons with HD.
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Affiliation(s)
- Janet K Williams
- College of Nursing, University of Iowa, Iowa City, IA 52242, USA.
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18
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Sousa VD, Williams JK, Barnette JJ, Reed DA. A new scale to measure family members' perception of community health care services for persons with Huntington disease. J Eval Clin Pract 2010; 16:470-5. [PMID: 20337834 PMCID: PMC2894287 DOI: 10.1111/j.1365-2753.2009.01144.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED RATIONALE, AIMS, AND OBJECTIVES: Huntington disease (HD) is a progressive genetic brain disease leading to disruptive cognitive, behavioural and physical impairments. Persons with the condition and their caregivers need appropriate and accessible health care services to help them manage the disease adequately. The purpose of this study was to evaluate the psychometric properties of a new scale that measures family members' perception of community health care services (CHCS) for persons with HD. METHODS A methodological design was used to examine the initial reliability and dimensionality of the CHCS scale among 245 family members of persons with a diagnosis of HD. Data analysis consisted of computing Cronbach's alpha coefficients, calculating the 95% confidence interval for alpha and performing item-analysis and exploratory factor analysis. RESULTS Reliability of the scale based on Cronbach's alpha was 0.83. Factor analysis using principal component analysis and varimax rotation suggested that three interpretable factors underlie the scale. Factor 1, HD knowledge, had alpha = 0.82, eigenvalue of 4.67 and explained 33.42% of the variance; factor 2, HD community resources, had alpha = 0.62, eigenvalue of 1.68 and explained 12.02% of the variance; factor 3, individualized HD management, had alpha = 0.77, eigenvalue of 1.45 and explained 10.39% of the variance. CONCLUSIONS Findings from this study provide evidence of both construct validity and internal consistency reliability of the CHCS scale. Further psychometric testing of the scale in other samples of family caregivers of persons with HD is warranted.
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Affiliation(s)
- Valmi D Sousa
- University of Kansas, School of Nursing, Kansas City, KS, USA.
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Alonso ME, Ochoa A, Sosa AL, Rodríguez Y, Chávez M, Boll C, Yescas P, Macías R, Rasmussen A. Presymptomatic diagnosis in Huntington's disease: the Mexican experience. Genet Test Mol Biomarkers 2010; 13:717-20. [PMID: 19810823 DOI: 10.1089/gtmb.2009.0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Huntington's disease (HD) is an autosomal dominant progressive, disabling neurodegenerative disorder, for which there is no effective treatment. Predictive testing (PT) for this illness began in 1986 and by 1993 it became more precise after cloning of the gene and the discovery of a CAG repeat expansion as the underlying cause. The objective of this paper is to illustrate the implementation and results of a PT program in a group of at-risk Mexican individuals with 12 years of follow-up. Our PT program conforms to the guidelines proposed by the International Huntington Association and the HD Working group of the World Federation of Neurology. Seventy-five individuals requested the testing, four of them did not fulfill the inclusion criteria, and five abandoned the program voluntarily before receiving the test results. Therefore, 66 results were delivered to 41 noncarriers and 25 mutation carriers. We did not have any catastrophic event, but 4 individuals with normal results and 11 mutation carriers were depressed. Even if this is a small sample, it is the first report of PT in a Latin-American population in which we have been faced with the same problems referred to in larger series.
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Affiliation(s)
- Maria Elisa Alonso
- Neurogenetics and Molecular Biology Department, Instituto Nacional de Neurología y Neurocirugía-Manuel Velasco Suárez (INNN-MVS), Mexico City, Mexico.
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Williams JK, Hamilton R, Nehl C, McGonigal-Kenney M, Schutte DL, Sparbel K, Birrer E, Tripp-Reimer T, Friedrich R, Penziner E, Jarmon L, Paulsen J. "No one else sees the difference: "family members' perceptions of changes in persons with preclinical Huntington disease. Am J Med Genet B Neuropsychiatr Genet 2007; 144B:636-41. [PMID: 17219384 DOI: 10.1002/ajmg.b.30479] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Manifestations of Huntington disease (HD) prior to clinical diagnosis are not well understood. This study documents adult family members' perceptions of changes and their attempts to manage these changes in persons who had received a positive predictive molecular HD test prior to clinical diagnosis. Data were obtained from 19 adult family members in six focus groups in the US and Canada and one individual interview in the US. Changes reported by family members included problems in cognition and behavior, which are consistent with prior reports. In addition, family members observed changes in motor functioning, the ability to complete usual activities at work or at home, and interpersonal relationships with family and friends. Family members attempted to manage these changes by taking on new responsibilities and preparing for future caregiving. Lack of information about preclinical HD, difficulty in understanding changes that may represent early stages of HD, and efforts to maintain secrecy of the preclinical HD situation contribute to compromising the abilities of family members to respond to changes in the person with preclinical HD. Findings provide insights into alterations in cognition, behavior, and functioning observed by the family members prior to clinical diagnosis. Findings further support the need for a more comprehensive assessment and management of early HD symptoms as well as support for family members.
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Affiliation(s)
- Janet K Williams
- College of Nursing, University of Iowa, Iowa City, Iowa 52242, USA.
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Abstract
Worldwide, predictive testing for Huntington's disease has become an accepted clinical application that has allowed many individuals from HD-families to proceed with their life without the uncertainty of being at risk. International guidelines have extensively contributed to establishing counselling programmes of high quality, and have served as a model for other genetic disorders. Psychological follow-up studies have increased the insight into the far-reaching impact of test results for all individuals involved. Although the guidelines have served as a useful frame of reference, clinical experience has shown the importance of a case-by-case approach to do justice to the specific needs of the individual test candidate. Issues such as ambiguous test results, lack of awareness in a test candidate of early signs of the disease, non-compliance to the test protocol, or the test candidate's need for information on the relationship between age at onset and CAG-repeat require careful consideration. Receiving a test result is only one of the transition points in the life of an individual at risk; such result needs to be valued from a life-cycle perspective.
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Affiliation(s)
- Aad Tibben
- Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.
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Decruyenaere M, Evers-Kiebooms G, Boogaerts A, Philippe K, Demyttenaere K, Dom R, Vandenberghe W, Fryns JP. The complexity of reproductive decision-making in asymptomatic carriers of the Huntington mutation. Eur J Hum Genet 2007; 15:453-62. [PMID: 17245406 DOI: 10.1038/sj.ejhg.5201774] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to describe reproductive decisions in mutation carriers after predictive testing for Huntington's disease (HD) and to identify factors that play a role in decision-making. In 1987-2004, 245 individuals received a predictive test result; 89 of them were carriers and seven received an equivocal result. Quantitative data on reproductive behaviour have been collected during all follow-up contacts. The follow-up time in this study was 1-16 years (mean: 7.1 years). Qualitative data on reproductive decision-making have been collected by the means of semistructured interviews during the 5-year follow-up study. For 46 carriers and two persons with an equivocal result, family planning was one of the motives for predictive testing. In this group, slightly more than half of the carriers (58%) had chosen to have children with prenatal diagnosis or preimplantation genetic diagnosis and about one in three (35%) decided to have no children anymore after the test. A minority (7%) was undecided or had no children for other reasons. Factors playing a role in the decision-making process were the carrier's sex, ethical issues about PD and PGD, the strength of the desire to have children, illness representations including personal experiences with HD in the family and the technological imperative. Some of these elements were in conflict and induced ambivalence towards reproductive choices. The results illustrate the complexity of the decision-making process and the necessity of in-depth counselling. Counselling should pay special attention to conflicting values and beliefs and to all kinds of pressure.
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