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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [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: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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Huntington's disease influences employment before and during clinical manifestation: A systematic review. Parkinsonism Relat Disord 2022; 96:100-108. [PMID: 35379551 DOI: 10.1016/j.parkreldis.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease. People at risk for HD can choose to get predictive testing years before the clinical onset. HD is characterized by motor, cognitive and psychiatric symptoms and has a mean age at onset between 30 and 50 years, an age at which people are usually still working. This systematic review focuses on summarizing which disease-specific characteristics influence employment and working capacity in HD. Twenty-three studies were identified and showed that while employment and working capacity in HD are negatively influenced by cognitive decline and motor impairments, apathy already plays a role in the prodromal stage. Moreover, the influence of HD transcends the clinical manifestation of the disease, as some people at risk are already experiencing the impact of HD on employment through fear of or actual genetic discrimination. Employment and working capacity are not influenced by predictive testing for HD in and of itself.
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Genetic Discrimination in Access to Life Insurance: Does Ukrainian Legislation Offer Sufficient Protection against the Adverse Consequences of the Genetic Revolution to Insurance Applicants? LAWS 2021. [DOI: 10.3390/laws11010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents an inter-disciplinary study of the risk for, and protections against, genetic discrimination in access to life insurance in Ukraine. It aims (i) to review questions related to genetic information, health status, and family history currently included in Ukrainian life insurance application forms; (ii) to analyze the Ukrainian legislation related to equity and nondiscrimination and to determine whether it provides adequate protection against genetic discrimination (GD). Research findings of our insurance application forms review show that Ukrainian life insurance companies ask broad questions about health and family history that may be perceived by applicants as requiring the disclosure of their genetic information. Our legal analysis shows that today there are no genetic specific law protecting Ukrainians people against GD in insurance. However, Ukrainian human rights legislation provides some protection against multiple grounds of discrimination and given the ratification by Ukraine of the European Convention on Human Rights it is possible that these grounds could be interpreted by tribunals as also including genetic characteristics. As a next step, Ukrainian researchers should develop a survey to obtain much needed data on the incidence and impact of GD in Ukraine. Following this it will be possible for policymakers to better assess whether there is a need for an explicit non-GD law in this country. Such a law would have the benefit of explicitly aligning Ukraine’s legal framework with that of many of its European partners.
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Mahmood S, Law S, Bombard Y. "I have to start learning how to live with becoming sick": A scoping review of the lived experiences of people with Huntington's disease. Clin Genet 2021; 101:3-19. [PMID: 34216010 DOI: 10.1111/cge.14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023]
Abstract
Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide. The experience of illness through a person's perspective is one domain defining PCC contributing to a growing interest in examining the lived experiences of illness. This scoping review sought to examine what is known from the existing literature about the lived experiences of persons gene-positive for or living with Huntington's disease (HD) as described in their own voices and to outline prominent psychosocial themes of those experiences. Five databases were systematically searched and analyzed resulting in 19 publications for inclusion. Using a thematic analysis, five prominent psychosocial themes were identified: grappling with control, avoidance as an escape from realities, adaptation to new realities, managing emotions, and appreciation for life. Variation in themes existed across HD life stage of being undiagnosed or diagnosed with HD. The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.
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Affiliation(s)
- Saadia Mahmood
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Service Research Group, St. Michael's Hospital - Unity Health Toronto, Toronto, Ontario, Canada
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5
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Kim H, Ho CWL, Ho CH, Athira PS, Kato K, De Castro L, Kang H, Huxtable R, Zwart H, Ives J, Lee I, Joly Y, Kim SY. Genetic discrimination: introducing the Asian perspective to the debate. NPJ Genom Med 2021; 6:54. [PMID: 34210984 PMCID: PMC8249378 DOI: 10.1038/s41525-021-00218-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/25/2021] [Indexed: 01/26/2023] Open
Abstract
Our article aims to provide a comprehensive portrayal of how seven Asian jurisdictions have sought to address the challenge of genetic discrimination (GD) by presenting an analysis of the relevant legislation, policies, and practices. Based on our findings, policy discussion and action on preventing or mitigating GD have been narrowly framed in terms of employment, insurance, disability, marriage, and family planning. Except for South Korea, none of the jurisdictions we examined has adopted specific legislation to prevent GD. However, for Asia to truly benefit from its recent scientific and technological progress in genomics, we highlight the need for these jurisdictions to engage more proactively with the challenges of GD through a coordinated regulatory and governance mechanism.
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Affiliation(s)
- Hannah Kim
- Asian Institute for Bioethics and Health Law, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - P S Athira
- National University of Advanced Legal Studies, Kochi, India
| | - Kazuto Kato
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Hub Zwart
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Ilhak Lee
- Asian Institute for Bioethics and Health Law, Yonsei University College of Medicine, Seoul, South Korea
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada.
| | - So Yoon Kim
- Asian Institute for Bioethics and Health Law, Yonsei University College of Medicine, Seoul, South Korea.
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6
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Wauters A, Van Hoyweghen I. Normalising life at risk of Huntington's disease. A qualitative study of backgrounds and coping strategies of fears of genetic discrimination. Eur J Hum Genet 2021; 29:940-948. [PMID: 33594260 PMCID: PMC8187417 DOI: 10.1038/s41431-021-00822-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 12/14/2022] Open
Abstract
Studies in the sociology of genetics have shown how living with a predisposition to a genetic disorder often comes with significant psycho-social burdens and struggles. One of these struggles is the fear of genetic discrimination. Despite genetic non-discrimination regulations, research shows people still worry about being subjected to genetic discrimination. This article adds to this existing body of literature by showing why people still worry about genetic discrimination and how they cope with these worries. Our findings derive from an analysis of semi-structured, in-depth interviews with individuals at risk for Huntington's disease (HD) in Belgium. Concerns of genetic discrimination are grounded in the participants' family backgrounds. Our participants, having witnessed numerous events in which symptomatic relatives suffered discrimination and stigmatisation, expressed heightened fears of facing genetic discrimination. Further, this article provides insight into the strategies participants use to cope with these fears. Two ways of normalising life were identified-while some persist in keeping their genetic risk a secret, other participants explicitly choose to be transparent about their genetic risk, desiring a level of openness. However, while they want to 'break' with their family background, participants who choose to be open are still held back by their worries about genetic discrimination by organisational actors. 'Normalising genetics' appears to be particularly challenging considering the remaining stereotypes and stigma surrounding genetic diseases.
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Affiliation(s)
- Annet Wauters
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, 45 - 3601, Parkstraat, Leuven, 3000, Belgium.
| | - Ine Van Hoyweghen
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, 45 - 3601, Parkstraat, Leuven, 3000, Belgium
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7
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Dalpé G, Pinkesz M, Oliviero E, Tolymbek M, Joly Y. Genetic discrimination views in online discussion forums: Perspectives from Canadian forumites. J Genet Couns 2021; 30:1613-1628. [PMID: 33871129 DOI: 10.1002/jgc4.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
Recent advancements in genetic technologies have made genetic information increasingly sought out in a wide range of non-therapeutic contexts, which has increased the risk that such information be used to discriminate against individuals. Frequently, it is genetic counselors who have to respond to questions about genetic discrimination (GD) from worried patients. Here, we examine the general Canadian public's knowledge, attitudes, and concerns about GD through a comprehensive analysis and categorization of posts from selected Canadian online discussion forums. Overall, we collected 1,638 posts, from which we coded 694 posts originating from newspaper comment sections and Reddit posts that were categorized to yield 6 main themes that consistently concerned Canadian users on the topics of GD: (a) discussions centered around how insurance business practices can be affected by genetic information; (b) issues in employment; (c) 'fear' of genetic testing and eugenics; (d) preventive approaches such as law and human rights instruments; (e) the predictive value and privacy that should be conferred to genetic information; and (f) other ethical issues. Overall, discussions addressed risk stratification models applied to genetic information and personal insurance underwriting. We find that many forum users (aka forumites) fear GD in insurance and employment, consider genetic information private, and strongly support different legal approaches to prevent GD. However, we find dissension among forumites that may represent different advocacy groups such as insurers and employers. From these important concerns and social conceptions, we discuss issues that should be taken into consideration for the development of future policies and information campaigns addressing GD in Canada and other countries.
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Affiliation(s)
- Gratien Dalpé
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Miriam Pinkesz
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Elisabeth Oliviero
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Maria Tolymbek
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Yann Joly
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
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8
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Oliveira CR, Mendes Á, Sequeiros J, Sousa L. Management of information within Portuguese families with Huntington disease: a transgenerational process for putting the puzzle together. Eur J Hum Genet 2020; 28:1210-1217. [PMID: 32341469 PMCID: PMC7608350 DOI: 10.1038/s41431-020-0630-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/28/2022] Open
Abstract
Huntington disease (HD) is a rare progressive neurological disease, with no cure, inherited in an autosomal dominant fashion, significantly impacting family relations, health and well-being. So far, no studies have reported how Portuguese families deal with information about HD, from a transgenerational perspective. This qualitative study aims to fill in that gap, and focuses on how families acquire knowledge about HD and management of information within the family and in their social relationships. The study adopted semi-structured interviews with 10 participants from HD families. Interviews were transcribed and analysed thematically. Findings suggested that management of information in the family started with the search for a diagnosis in an affected family member. Diagnosis led to a process of "making sense of HD in the family", which activated a transgenerational process to understand HD in the family context, marked by improved awareness and different ways family members manage it (closedness and openness). These results should be relevant for health-care professionals, bringing further insight into the process of acquiring knowledge about HD, and highlighting the relevance of continued efforts for enhanced pre- and post-test counselling and ongoing support to the HD families.
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Affiliation(s)
- Carla Roma Oliveira
- Department of Education and Psychology, CINTESIS (Centre for Health Technology and Services Research), University of Aveiro, Aveiro, Portugal.
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - Álvaro Mendes
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Jorge Sequeiros
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Univ. Porto, Portugal; and ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Liliana Sousa
- Department of Education and Psychology, CINTESIS (Centre for Health Technology and Services Research), University of Aveiro, Aveiro, Portugal
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9
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Joly Y, Dupras C, Pinkesz M, Tovino SA, Rothstein MA. Looking Beyond GINA: Policy Approaches to Address Genetic Discrimination. Annu Rev Genomics Hum Genet 2020; 21:491-507. [DOI: 10.1146/annurev-genom-111119-011436] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Concerns about genetic discrimination (GD) often surface when discussing research and innovation in genetics. Over recent decades, countries around the world have attempted to address GD using various policy measures. In this article, we survey these approaches and provide a critical commentary on their advantages and disadvantages. Our examination begins with regions featuring extensive policy-making activities (North America and Europe), followed by regions with moderate policy-making activities (Australia, Asia, and South America) and regions with minimal policy-making activities (the Middle East and Africa). Our analysis then turns to emerging issues regarding genetic testing and GD, including the expansion of multiomics sciences and direct-to-consumer genetic tests outside the health context. We additionally survey the shortcomings of current normative approaches addressing GD. Finally, we conclude by highlighting the evolving nature of GD and the need for more innovative policy-making in this area.
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Affiliation(s)
- Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
| | - Charles Dupras
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
| | - Miriam Pinkesz
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
| | - Stacey A. Tovino
- William S. Boyd School of Law, University of Nevada, Las Vegas, Nevada 89154, USA
| | - Mark A. Rothstein
- Brandeis School of Law and School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA
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10
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Stainsby BE, Mior S, Guttman M. Locus of control in patients with Huntington disease: a cross-sectional study. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2020; 64:65-75. [PMID: 32476669 PMCID: PMC7250512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health locus of control (LOC) represents an individual's beliefs regarding one's ability to influence health outcomes. In patients with chronic and neurodegenerative diseases, greater internal LOC has been associated with lower levels of disability. OBJECTIVE To examine LOC in patients with Huntington disease (HD). METHODS A cross-sectional study of individuals affected by HD, stratified by disease status, was conducted. Participants completed a demographic questionnaire, the Internal Control Index (ICI), and the Hospital Anxiety and Depression Scales. RESULTS Thirty-four subjects completed the study. All groups demonstrated greater internal LOC (measured by ICI scores), and significant differences between groups were observed. Secondary analysis demonstrated relationships between depressive symptoms and anxiety symptoms, and ICI score and time from clinical diagnosis of HD. CONCLUSION As patients with chronic pain and neurodegenerative diseases such as HD are likely to present for chiropractic care, identifying factors such as anxiety, depression and LOC may affect patients' response to care.
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Affiliation(s)
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Mark Guttman
- Center for Movement Disorders, Toronto, Ontario, Canada
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11
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Bombard Y, Heim-Myers B. The Genetic Non-Discrimination Act: critical for promoting health and science in Canada. CMAJ 2019; 190:E579-E580. [PMID: 29759963 DOI: 10.1503/cmaj.180298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto (Bombard); Li Ka Shing Knowledge Institute, St. Michael's Hospital (Bombard), Toronto, Ont.; Huntington Society of Canada (Heim-Myers); Canadian Coalition for Genetic Fairness (Heim-Myers), Kitchener, Ont.
| | - Bev Heim-Myers
- Institute of Health Policy, Management and Evaluation, University of Toronto (Bombard); Li Ka Shing Knowledge Institute, St. Michael's Hospital (Bombard), Toronto, Ont.; Huntington Society of Canada (Heim-Myers); Canadian Coalition for Genetic Fairness (Heim-Myers), Kitchener, Ont
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12
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Concerns about Genetic Discrimination after Regulation: A Qualitative Study of the Situation Regarding BRCA and Huntington’s Disease in Belgium. LAWS 2018. [DOI: 10.3390/laws7020017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Amendola LM, Robinson JO, Hart R, Biswas S, Lee K, Bernhardt BA, East K, Gilmore MJ, Kauffman TL, Lewis KL, Roche M, Scollon S, Wynn J, Blout C. Why Patients Decline Genomic Sequencing Studies: Experiences from the CSER Consortium. J Genet Couns 2018; 27:1220-1227. [PMID: 29497922 DOI: 10.1007/s10897-018-0243-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/18/2018] [Indexed: 01/02/2023]
Abstract
Clinical and research settings are increasingly incorporating genomic sequencing (GS) technologies. Previous research has explored reasons for declining genetic testing and participation in genetic studies; however, there is a dearth of literature regarding why potential participants decline participation in GS research, and if any of these reasons are unique to GS. This knowledge is essential to promote informed decision-making and identify potential barriers to research participation and clinical implementation. We aggregated data from seven sites across the National Institutes of Health's Clinical Sequencing Exploratory Research (CSER) consortium on each project's procedures for recruitment, and rates of and reasons for decline. Data were analyzed using descriptive statistics. The decline rate for enrollment at the seven CSER sites ranged from 12 to 64% (median 28%) and varied based on age and disease status. Projects differed in their protocols for approaching potential participants and obtaining informed consent. Reasons for declining GS research were reported for 1088 potential participants. Commonly cited reasons were similar to those reported for clinical single gene testing and non-GS genetic research. The most frequently cited reason for decline was study logistics (35%); thus, addressing logistical barriers to enrollment may positively impact GS study recruitment. Privacy and discrimination concerns were cited by 13% of decliners, highlighting the need for researchers and providers to focus educational efforts in this area. The potential psychological burden of pursuing and receiving results from GS and not wanting to receive secondary findings, a concern specific to GS, have been cited as concerns in the literature. A minority of potential participants cited psychological impact (8%) or not wanting to receive secondary findings (2%) as reasons for decline, suggesting that these concerns were not major barriers to participation in these GS studies. Further research is necessary to explore the impact, if any, of different participant groups or study protocols on rates of decline for GS studies. Future studies exploring GS implementation should consider using standardized collection methods to examine reasons for decline in larger populations and more diverse healthcare settings.
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Affiliation(s)
- Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ragan Hart
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sawona Biswas
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.,Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kaitlyn Lee
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kelly East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, 35806, USA
| | - Marian J Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR, 97227, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, 97227, USA
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Myra Roche
- Departments of Pediatrics and Genetics, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Julia Wynn
- Department of Pediatrics, Columbia University, New York, NY, 10032, USA
| | - Carrie Blout
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
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14
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The Effect of Predictive Testing in Adult-Onset Neurodegenerative Diseases on Social and Personal Life. J Genet Couns 2017; 27:947-954. [DOI: 10.1007/s10897-017-0195-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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15
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Discredited legacy: Stigma and familial amyloid polyneuropathy in Northwestern Portugal. Soc Sci Med 2017; 182:73-80. [DOI: 10.1016/j.socscimed.2017.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 04/03/2017] [Accepted: 04/14/2017] [Indexed: 02/06/2023]
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16
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Wauters A, Van Hoyweghen I. Global trends on fears and concerns of genetic discrimination: a systematic literature review. J Hum Genet 2016; 61:275-82. [PMID: 26740237 DOI: 10.1038/jhg.2015.151] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/12/2015] [Accepted: 11/11/2015] [Indexed: 12/29/2022]
Abstract
Since the 1990s, developments in the field of genetics have led to many questions on the use and possible misuse of genetic information. 'Genetic discrimination' has been defined as the differential treatment of asymptomatic individuals or their relatives on the basis of their real or assumed genetic characteristics. Despite the public policy attention around genetic discrimination, there is currently still much confusion surrounding this phenomenon. On the one hand, there is little evidence of the occurrence of genetic discrimination. On the other hand, it appears that people remain concerned about this theme, and this fear influences their health and life choices. This article makes use of a systematic literature review to investigate what is already known about the nature, extent and background of these fears and concerns. The 42 included studies have found considerable levels of concerns about genetic discrimination. Concerns dominate in insurance contexts and within personal interactions. The extent of concerns appears to vary depending on the type of genetic illness. Furthermore, installed laws prohibiting genetic discrimination do not seem to alleviate existing fears. This raises important questions as to the origins of these fears. Based on the findings, recommendations for future research are made. First, research on the background of fears is needed. Second, future research needs to assess more fully all different forms (for example, direct and indirect) of genetic discrimination. Thirdly, it has to be studied whether genetic discrimination is a form of discrimination that is distinguishable from discrimination based on an illness or disability. Finally, a last element that should be addressed in future research is the most recent developments in research on genomics, such as next-generation sequencing or genome-wide association studies.
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Affiliation(s)
- Annet Wauters
- Life Sciences and Society Lab, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Ine Van Hoyweghen
- Life Sciences and Society Lab, Centre for Sociological Research, KU Leuven, Leuven, Belgium
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17
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Genetics and Personal Insurance: the Perspectives of Canadian Cancer Genetic Counselors. J Genet Couns 2015; 24:1022-36. [PMID: 25925606 PMCID: PMC4643106 DOI: 10.1007/s10897-015-9841-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 04/08/2015] [Indexed: 11/26/2022]
Abstract
Genetic discrimination in the context of genetic testing has been identified as a concern for symptomatic and asymptomatic individuals for more than three decades. Genetic counselors are often the health care professionals who discuss risks and benefits of genetic testing with patients, thereby making them most appropriate to address patient concerns about genetics and personal insurance (i.e., life, life as related to mortgage or group insurance, disability, critical illness and travel). A pilot study was conducted to ascertain the current practices of Canadian cancer genetic counselors in regard to their discussions with patients about genetic testing and access to personal insurance. Among the 36 counselors surveyed, 100 % reported discussing the issue of genetic testing and personal insurance with their patients. Several factors influenced the content, depth and length of these discussions including age, cancer status, family members, and patients’ current and future insurance needs. Counselors reported discussing with patients the possible impact of genetic test results on access to personal insurance, possible access and use of patient genetic information by insurance companies, and whom patients should contact if they have additional questions. The most commonly reported inquiries from patients included questions about the possible impact of genetic testing on their ability to obtain insurance, and the insurability of family members. While 28 % of counselors reported having been contacted by an insurer requesting access to patient information, only one counselor was aware of or could recall the outcome of such a request. This pilot study revealed that issues concerning genetics and personal insurance are commonly discussed in Canadian cancer genetic counseling sessions. Counselors furthermore expressed a need for additional educational resources on the topic of genetics and personal insurance for themselves and their patients.
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Kim SYH, Karlawish J, Berkman BE. Ethics of genetic and biomarker test disclosures in neurodegenerative disease prevention trials. Neurology 2015; 84:1488-94. [PMID: 25762713 PMCID: PMC4395889 DOI: 10.1212/wnl.0000000000001451] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/18/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Prevention trials for neurodegenerative diseases use genetic or other risk marker tests to select participants but there is concern that this could involve coercive disclosure of unwanted information. This has led some trials to use blinded enrollment (participants are tested but not told of their risk marker status). We examined the ethics of blinded vs transparent enrollment using well-established criteria for assessing the ethics of clinical research. METHODS Normative analysis applying 4 key ethical criteria-favorable risk-benefit ratio, informed consent, fair subject selection, and scientific validity-to blinded vs transparent enrollment, using current evidence and state of Alzheimer disease (AD) and other prevention trials. RESULTS Current evidence on the psychosocial impact of risk marker disclosure and considerations of scientific benefit do not support an obligation to use blinded enrollment in prevention trials. Nor does transparent enrollment coerce or involve undue influence of potential participants. Transparent enrollment does not unfairly exploit vulnerable participants or limit generalizability of scientific findings of prevention trials. However, if the preferences of a community of potential participants would affect the rigor or feasibility of a prevention trial using transparent enrollment, then investigators are required by considerations of scientific validity to use blinded enrollment. CONCLUSIONS Considerations of risks and benefits, informed consent, and fair subject selection do not require the use of blinded enrollment for AD prevention trials. Blinded enrollment in AD prevention trials may sometimes be necessary because of the need for scientific validity, not because it prevents coercion or undue influence.
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Affiliation(s)
- Scott Y H Kim
- From the Department of Bioethics, Clinical Center (S.Y.H.K., B.E.B.), National Institutes of Health, Bethesda, MD; and the Departments of Medicine and Medical Ethics and Health Policy (J.K.), University of Pennsylvania, Perelman School of Medicine, Philadelphia.
| | - Jason Karlawish
- From the Department of Bioethics, Clinical Center (S.Y.H.K., B.E.B.), National Institutes of Health, Bethesda, MD; and the Departments of Medicine and Medical Ethics and Health Policy (J.K.), University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Benjamin E Berkman
- From the Department of Bioethics, Clinical Center (S.Y.H.K., B.E.B.), National Institutes of Health, Bethesda, MD; and the Departments of Medicine and Medical Ethics and Health Policy (J.K.), University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Making the Decision to Participate in Predictive Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy. J Genet Couns 2014; 23:1045-55. [DOI: 10.1007/s10897-014-9733-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Paulsen JS, Nance M, Kim JI, Carlozzi NE, Panegyres PK, Erwin C, Goh A, McCusker E, Williams JK. A review of quality of life after predictive testing for and earlier identification of neurodegenerative diseases. Prog Neurobiol 2013; 110:2-28. [PMID: 24036231 PMCID: PMC3833259 DOI: 10.1016/j.pneurobio.2013.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/12/2022]
Abstract
The past decade has witnessed an explosion of evidence suggesting that many neurodegenerative diseases can be detected years, if not decades, earlier than previously thought. To date, these scientific advances have not provoked any parallel translational or clinical improvements. There is an urgency to capitalize on this momentum so earlier detection of disease can be more readily translated into improved health-related quality of life for families at risk for, or suffering with, neurodegenerative diseases. In this review, we discuss health-related quality of life (HRQOL) measurement in neurodegenerative diseases and the importance of these "patient reported outcomes" for all clinical research. Next, we address HRQOL following early identification or predictive genetic testing in some neurodegenerative diseases: Huntington disease, Alzheimer's disease, Parkinson's disease, Dementia with Lewy bodies, frontotemporal dementia, amyotrophic lateral sclerosis, prion diseases, hereditary ataxias, Dentatorubral-pallidoluysian atrophy and Wilson's disease. After a brief report of available direct-to-consumer genetic tests, we address the juxtaposition of earlier disease identification with assumed reluctance toward predictive genetic testing. Forty-one studies examining health-related outcomes following predictive genetic testing for neurodegenerative disease suggested that (a) extreme or catastrophic outcomes are rare; (b) consequences commonly include transiently increased anxiety and/or depression; (c) most participants report no regret; (d) many persons report extensive benefits to receiving genetic information; and (e) stigmatization and discrimination for genetic diseases are poorly understood and policy and laws are needed. Caution is appropriate for earlier identification of neurodegenerative diseases but findings suggest further progress is safe, feasible and likely to advance clinical care.
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Affiliation(s)
- Jane S Paulsen
- Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychology, University of Iowa, Iowa City, IA, USA.
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Joly Y, Ngueng Feze I, Simard J. Genetic discrimination and life insurance: a systematic review of the evidence. BMC Med 2013; 11:25. [PMID: 23369270 PMCID: PMC3606414 DOI: 10.1186/1741-7015-11-25] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the late 1980s, genetic discrimination has remained one of the major concerns associated with genetic research and clinical genetics. Europe has adopted a plethora of laws and policies, both at the regional and national levels, to prevent insurers from having access to genetic information for underwriting. Legislators from the United States and the United Kingdom have also felt compelled to adopt protective measures specifically addressing genetics and insurance. But does the available evidence really confirm the popular apprehension about genetic discrimination and the subsequent genetic exceptionalism? METHODS This paper presents the results of a systematic, critical review of over 20 years of genetic discrimination studies in the context of life insurance. RESULTS The available data clearly document the existence of individual cases of genetic discrimination. The significance of this initial finding is, however, greatly diminished by four observations. First, the methodology used in most of the studies is not sufficiently robust to clearly establish either the prevalence or the impact of discriminatory practices. Second, the current body of evidence was mostly developed around a small number of 'classic' genetic conditions. Third, the heterogeneity and small scope of most of the studies prevents formal statistical analysis of the aggregate results. Fourth, the small number of reported genetic discrimination cases in some studies could indicate that these incidents took place due to occasional errors, rather than the voluntary or planned choice, of the insurers. CONCLUSION Important methodological limitations and inconsistencies among the studies considered make it extremely difficult, at the moment, to justify policy action taken on the basis of evidence alone. Nonetheless, other empirical and theoretical factors have emerged (for example, the prevalence and impact of the fear of genetic discrimination among patients and research participants, the (un)importance of genetic information for the commercial viability of the private life insurance industry, and the need to develop more equitable schemes of access to life insurance) that should be considered along with the available evidence of genetic discrimination for a more holistic view of the debate.
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Affiliation(s)
- Yann Joly
- Department of Human Genetics, Faculty of Medicine, McGill University, 740 Dr Penfield Avenue, Suite 5200, Montreal, H3A 1A5 Canada.
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Abstract
The field of neurogenetics is moving so rapidly that new discoveries are announced almost weekly. The tools available for the diagnosis of neurogenetic disorders have become powerful and complex, and raise new ethical dilemmas that did not exist just a few years ago. In addition to previous concerns about presymptomatic genetic testing and carrier testing, the widening availability of next-generation sequencing raises concerns about the reporting of incidental findings of unclear significance. Genetically targeted therapies have now been proven to be efficacious for a few neurogenetic diseases, and it is likely that gene therapies and cell-based therapies will soon be applied to other neurologic disorders. These therapies are generally quite expensive compared to other treatments. Given the cost constraints that will be needed in the healthcare system in the United States and other countries, and the likelihood that new genetically targeted therapies will be introduced, society will face difficult questions regarding its obligations to fund expensive therapies both for large populations and for small numbers of patients with rare diseases. Potential conflicts of interest involving both individuals and institutions will need ongoing vigilance. Scientific advances will continue to raise consequential ethical questions in the field of neurogenetics.
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Otlowski M, Taylor S, Bombard Y. Genetic Discrimination: International Perspectives. Annu Rev Genomics Hum Genet 2012; 13:433-54. [DOI: 10.1146/annurev-genom-090711-163800] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - S. Taylor
- School of Sociology and Social Work, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Y. Bombard
- Department of Epidemiology and Public Health, Division of Health Policy and Administration, Yale University, New Haven, Connecticut 06510
- Department of Epidemiology and Biostatistics, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY 10065;
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MacLeod R, Tibben A, Frontali M, Evers-Kiebooms G, Jones A, Martinez-Descales A, Roos RA. Recommendations for the predictive genetic test in Huntington's disease. Clin Genet 2012; 83:221-31. [PMID: 22642570 DOI: 10.1111/j.1399-0004.2012.01900.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/08/2012] [Accepted: 05/22/2012] [Indexed: 01/27/2023]
Affiliation(s)
- R MacLeod
- Genetic Medicine, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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Unravelling fears of genetic discrimination: an exploratory study of Dutch HCM families in an era of genetic non-discrimination acts. Eur J Hum Genet 2012; 20:1018-23. [PMID: 22453290 DOI: 10.1038/ejhg.2012.53] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Since the 1990s, many countries in Europe and the United States have enacted genetic non-discrimination legislation to prevent people from deferring genetic tests for fear that insurers or employers would discriminate against them based on that information. Although evidence for genetic discrimination exists, little is known about the origins and backgrounds of fears of discrimination and how it affects decisions for uptake of genetic testing. The aim of this article is to gain a better understanding of these fears and its possible impact on the uptake of testing by studying the case of hypertrophic cardiomyopathy (HCM). In a qualitative study, we followed six Dutch extended families involved in genetic testing for HCM for three-and-a-half years. Semi-structured interviews were conducted with 57 members of these families. Based on the narratives of the families, we suggest that fears of discrimination have to be situated in the broader social and life-course context of family and kin. We describe the processes in which families developed meaningful interpretations of genetic discrimination and how these interpretations affected family members' decisions to undergo genetic testing. Our findings show that fears of genetic discrimination do not so much stem from the opportunity of genetic testing but much more from earlier experiences of discrimination of diseased family members. These results help identify the possible limitations of genetic non-discrimination regulations and provide direction to clinicians supporting their clients as they confront issues of genetic testing and genetic discrimination.
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Bombard Y, Palin J, Friedman JM, Veenstra G, Creighton S, Bottorff JL, Hayden MR. Beyond the patient: the broader impact of genetic discrimination among individuals at risk of Huntington disease. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:217-26. [PMID: 22231990 DOI: 10.1002/ajmg.b.32016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 12/07/2011] [Indexed: 11/07/2022]
Abstract
We aimed to address gaps in current understanding of the scope and impact of discrimination, by examining a cohort of individuals at-risk for Huntington disease (HD), to describe the prevalence of concern for oneself and one's family in multiple domains; strategies used to mitigate discrimination; and the extent to which concerns relate to experiences. We conducted a cross-sectional survey of 293 individuals at-risk for HD (80% response rate); 167 respondents were genetically tested and 66 were not. Fear of discrimination was widespread (86%), particularly in the insurance, family and social settings. Approximately half of concerned individuals experienced discrimination (40-62%, depending on genetic status). Concern was associated with "keeping quiet" about one's risk of HD or "taking action to avoid" discrimination. Importantly, concern was highly distressing for some respondents (21% for oneself; 32% for relatives). Overall, concerned respondents with high education levels, who discovered their family history at a younger age, and those who were mutation-positive were more likely to report experiences of discrimination than others who were concerned. Concerns were rarely attributed to genetic test results alone. Concern about genetic discrimination is frequent among individuals at-risk of HD and spans many settings. It influences behavioral patterns and can result in high levels of self-rated distress, highlighting the need for practice and policy interventions. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Yvonne Bombard
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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Bombard Y, Cox SM, Semaka A. When They Hear What We Say: Ethical Challenges in Presenting Research Findings to the Huntington Disease Community. J Empir Res Hum Res Ethics 2011; 6:47-54. [DOI: 10.1525/jer.2011.6.3.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sharing findings with the Huntington disease (HD) community and other genetic disease communities is challenging because of the sensitivity involved in effectively communicating findings to participants. We describe our experiences of presenting multi-disciplinary research findings to the HD community, and discuss the need to: (1) balance potential benefits and harms for participants, researchers, and others; (2) demonstrate respect for participants' needs, expectations, and priorities; and (3) ensure transparency and respect for autonomy.
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28
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Halpin M. Diagnosis, psychiatry and neurology: The case of Huntington Disease. Soc Sci Med 2011; 73:858-65. [DOI: 10.1016/j.socscimed.2011.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 03/20/2011] [Accepted: 03/23/2011] [Indexed: 11/29/2022]
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Shostak S, Zarhin D, Ottman R. What's at stake? Genetic information from the perspective of people with epilepsy and their family members. Soc Sci Med 2011; 73:645-54. [PMID: 21831495 PMCID: PMC3163050 DOI: 10.1016/j.socscimed.2011.06.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 06/20/2011] [Accepted: 06/23/2011] [Indexed: 02/04/2023]
Abstract
Substantial progress has been made in identifying genes that raise risk for epilepsy, and genetic testing for some of these genes is increasingly being used in clinical practice. However, almost no empirical data are available from the perspective of people with epilepsy and their family members about the impact of genetic information and potential benefits and harms of genetic testing. To address this gap we conducted in-depth qualitative interviews with 40 individuals (22 with epilepsy, 18 unaffected) in the USA from families containing multiple affected individuals who had participated in epilepsy genetics research. The interviews were coded and analyzed using the principles of grounded theory. Several major themes emerged from these interviews. Participants expressed "personal theories of inheritance" that emphasized commonalities among relatives and the idea that disease risk is most shared by family members who share physical or personality traits. Most participants said they would have genetic testing if it were offered. They cited many potential benefits, including learning what caused epilepsy in their family, being better able to care and advocate for children at risk, reducing guilt and blame, providing an increased sense of control, and relieving anxiety in unaffected individuals who test negative. The influence of genetic information on reproduction was a particularly salient theme. Although respondents believed genetic testing would be useful for informing their reproductive choices, they also expressed fear that it could lead to external pressures to modify these choices. Other concerns about the potential negative impact of genetic information included increased blame and guilt, increased stigma and discrimination in employment and insurance, self-imposed limitations on life goals, and alterations in fundamental conceptions of "what epilepsy is." Consideration of the perspectives of people with epilepsy and their family members is critical to understanding the implications of contemporary epilepsy genetic research and testing.
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Affiliation(s)
- Sara Shostak
- Brandeis University, Department of Sociology, MS 071, Waltham, MA 02454-9110, USA.
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30
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Kang PB. Presymptomatic and Early Symptomatic Genetic Testing. Continuum (Minneap Minn) 2011; 17:343-6. [DOI: 10.1212/01.con.0000396969.13188.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bombard Y, Semaka A, Hayden MR. Adoption and the communication of genetic risk: experiences in Huntington disease. Clin Genet 2011; 81:64-9. [PMID: 21204796 DOI: 10.1111/j.1399-0004.2010.01614.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adoption agencies can use genetic information to determine the eligibility of prospective adoptive parents and to establish a child's suitability for adoption. We describe experiences and implications of communicating genetic risk for Huntington disease (HD) in the context of adoption. A secondary analysis was employed using data collected from a cross-sectional survey (n = 233) and two qualitative studies on the psychosocial effects of predictive testing for HD. We demonstrate several ethical and practical challenges in the search for and communication of genetic information for adoptees and their birth relatives. We also found that concern for adoption discrimination was reported by 13.7% of survey respondents (n = 32). Concerns were higher among tested respondents than those who had not been tested (n = 29 vs n = 3, p = 0.010). However, more respondents were concerned about being discriminated based on their family history (FHx) vs their genetic test results (GTR) (concern based on FHx: n = 18 vs based on GTR: n = 1 vs based on both: n =10). These findings contribute to the limited empirical literature by offering evidence on the experiences and implications of communicating genetic risk information in the context of adoption with reference to HD.
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Affiliation(s)
- Y Bombard
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4 Canada.
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Bombard Y, Palin J, Friedman JM, Veenstra G, Creighton S, Paulsen JS, Bottorff JL, Hayden MR. Factors associated with experiences of genetic discrimination among individuals at risk for Huntington disease. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:19-27. [PMID: 21184581 PMCID: PMC3860279 DOI: 10.1002/ajmg.b.31130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to identify factors that are associated with experiencing genetic discrimination (GD) among individuals at risk for Huntington disease (HD). Multivariable logistic regression analysis was used to examine factors associated with experiencing GD in data from a cross-sectional, self-report survey of 293 individuals at risk for HD. The study sample comprised 167 genetically tested respondents, and 66 who were not tested (80% response rate). Overall, individuals who learn they are at risk for HD at a younger age (OR = 3.1; 95% CI: 1.5-6.2; P = 0.002), are mutation-positive (OR = 2.8; 95% CI: 1.4-6.0; P = 0.006), or are highly educated (OR = 2.7; 95% CI: 1.4-5.1; P = 0.002) are more likely to experience GD, particularly in insurance, family, and social settings. Further, younger age was associated with discrimination in insurance (OR = 0.97; 95% CI: 0.94-1.00; P = 0.038). This study provides evidence that some people who are at risk for HD were more likely to experience GD than others. Individuals who learned they are at risk for HD at a younger age and those who are mutation-positive were more likely to experience GD, particularly in insurance, family, and social settings. Younger individuals were more likely to experience discrimination in the insurance setting. Overall, highly educated individuals were also more likely to report discrimination. These results provide direction for clinical and family discussions, counseling practice, and policy aimed at mitigating experiences of GD.
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Affiliation(s)
- Yvonne Bombard
- Department of Medical Genetics, University of British Columbis, Vancouver, BC, Canada,Department of Health policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - JoAnne Palin
- Department of Medical Genetics, University of British Columbis, Vancouver, BC, Canada
| | - Jan M. Friedman
- Children’s & Women’s Hospital of British Columbia, Vancouver, BC, Canada
| | - Gerry Veenstra
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Susan Creighton
- Children’s & Women’s Hospital of British Columbia, Vancouver, BC, Canada
| | - Jane S. Paulsen
- Departments of Psychiatry, Neurology, Psychology and Neurosciences, University of Iowa, Iowa City, Iowa
| | - Joan L. Bottorff
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Michael R. Hayden
- Department of Medical Genetics, University of British Columbis, Vancouver, BC, Canada,Centre for Molecular Medicine & Therapeutics, Child & Family Research Institute, Department of Medical Genetics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, Canada V5Z 4H4. Michael R. Hayden ()
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Williams JK, Erwin C, Juhl AR, Mengeling M, Bombard Y, Hayden MR, Quaid K, Shoulson I, Taylor S, Paulsen JS. In their own words: reports of stigma and genetic discrimination by people at risk for Huntington disease in the International RESPOND-HD study. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1150-9. [PMID: 20468062 PMCID: PMC3035936 DOI: 10.1002/ajmg.b.31080] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Genetic discrimination may be experienced in the day-to-day lives of people at risk for Huntington disease (HD), encompassing occurrences in the workplace, when seeking insurance, within social relationships, and during other daily encounters. At-risk individuals who have tested either positive or negative for the genetic expansion that causes HD, as well as at-risk persons with a 50% chance for developing the disorder but have not had DNA testing completed the International RESPOND-HD (I-RESPOND-HD) survey. One of the study's purposes was to examine perceptions of genetic stigmatization and discrimination. A total of 412 out of 433 participants provided narrative comments, and 191 provided related codable narrative data. The core theme, Information Control, refers to organizational policies and interpersonal actions. This theme was found in narrative comments describing genetic discrimination perceptions across employment, insurance, social, and other situations. These reports were elaborated with five themes: What They Encountered, What They Felt, What Others Did, What They Did, and What Happened. Although many perceptions were coded as hurtful, this was not true in all instances. Findings document that reports of genetic discrimination are highly individual, and both policy as well as interpersonal factors contribute to the outcome of potentially discriminating events.
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Affiliation(s)
| | - Cheryl Erwin
- University of Texas Medical School at Houston, John P. McGovern Center for Health, Humanities and the Human Spirit, Department of Family Medicine, Houston, Texas
| | - Andrew R Juhl
- College of Medicine, Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Michelle Mengeling
- College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Yvonne Bombard
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Hayden
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Quaid
- Indiana University Center for Bioethics, Indianapolis, Indiana
| | - Ira Shoulson
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Sandra Taylor
- University of Tasmania, Launceston, Tasmania, Australia
| | - Jane S Paulsen
- College of Medicine, Department of Psychiatry, University of Iowa, Iowa City, Iowa
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Erwin C, Williams JK, Juhl AR, Mengeling M, Mills JA, Bombard Y, Hayden MR, Quaid K, Shoulson I, Taylor S, Paulsen JS. Perception, experience, and response to genetic discrimination in Huntington disease: the international RESPOND-HD study. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1081-93. [PMID: 20468061 PMCID: PMC3593716 DOI: 10.1002/ajmg.b.31079] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Genetic discrimination-defined as the denial of rights, privileges, or opportunities or other adverse treatment based solely on genetic information (including family history)-is an important concern to patients, healthcare professionals, lawmakers, and family members at risk for carrying a deleterious gene. Data from the United States, Canada, and Australia were collected from 433 individuals at risk for Huntington disease (HD) who have tested either positive or negative for the gene that causes HD and family members of affected individuals who have a 50% risk for developing the disorder but remain untested. Across all three countries, a total of 46.2% of respondents report genetic discrimination or stigma based on either their family history of HD or genetic testing for the HD gene mutation. We report on the overall incidence of discrimination and stigma in the domains of insurance (25.9%), employment (6.5%), relationships (32.9%), and other transactions (4.6%) in the United States, Canada, and Australia combined. The incidence of self-reported discrimination is less than the overall worry about the risk of discrimination, which is more prevalent in each domain. Despite a relatively low rate of perceived genetic discrimination in the areas of health insurance and employment, compared to the perception of discrimination and stigma in personal relationships, the cumulative burden of genetic discrimination across all domains of experience represents a challenge to those at risk for HD. The effect of this cumulative burden on daily life decisions remains unknown.
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Affiliation(s)
- Cheryl Erwin
- Department of Family Medicine, John P. McGovern Center for Health, Humanities and the Human Spirit, University of Texas Medical School at Houston, Houston, Texas
| | | | - Andrew R. Juhl
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, Iowa
| | - Michelle Mengeling
- Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Yvonne Bombard
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael R. Hayden
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Quaid
- Indiana University Center for Bioethics, Indianapolis, Indiana
| | - Ira Shoulson
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Sandra Taylor
- University of Tasmania, Launceston, Tasmania, Australia
| | - Jane S. Paulsen
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, Iowa
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Strømsvik N, Råheim M, Oyen N, Engebretsen LF, Gjengedal E. Stigmatization and male identity: Norwegian males' experience after identification as BRCA1/2 mutation carriers. J Genet Couns 2010; 19:360-70. [PMID: 20306122 DOI: 10.1007/s10897-010-9293-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 02/24/2010] [Indexed: 01/10/2023]
Abstract
In families with hereditary breast and ovarian cancer, there is limited knowledge about the reactions of BRCA1/2 mutation positive males. In the present qualitative study, fifteen BRCA1/2 mutation positive men in Norway participated in two successive, in-depth interviews. Seven female partners participated in the second interview. The men reported strong emotional reactions to their positive test results, and they expressed a desire to keep the genetic information private. They considered discussing their test results or health related information with other males as difficult, and they perceived females as their sources of social and emotional support. Interestingly, the second interview revealed important information not communicated during the first interview. The findings of this study contribute to the discussion of whether men who test positive for a BRCA1/2 mutation should receive tailored genetic counseling sessions. Health care providers should be aware of psychological vulnerability in these men, likely stemming from fewer emotional supports in their social networks.
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Affiliation(s)
- Nina Strømsvik
- Western Norway Familial Cancer Center, Haukeland University Hospital, N-5021 Bergen, Norway.
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Grubs RE, Piantanida M. Grounded Theory in Genetic Counseling Research: An Interpretive Perspective. J Genet Couns 2010; 19:99-111. [DOI: 10.1007/s10897-009-9270-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 10/15/2009] [Indexed: 02/03/2023]
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Abstract
Huntington disease (HD) is a devastating illness, although its autosomal dominant genetic transmission allows a unique opportunity to study apparently healthy individuals before manifest disease. Attempts to study early disease are not unique in neurology (e.g., Mild Cognitive Impairment, Vascular Cognitive Impairment), but studying otherwise-healthy appearing individuals who will go on with nearly 99% certainty to manifest the symptoms of brain disease does provide distinct but valuable information about the true natural history of the disease. The field has witnessed an explosion of research examining possible early indicators of HD during what is now referred to as the "prodrome" of HD. A NIH study in its ninth year (PREDICT-HD) has offered a glimpse into the transition from an apparently healthy state to an obviously diseased state, and can serve as a model for many other genetic diseases, both neurological and non-neurological.
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Affiliation(s)
- Jane S Paulsen
- University of Iowa, The Roy J. and Lucille A. Carver College of Medicine, Departments of Psychiatry, Neurology, Neurosciences, and Psychology, Iowa City, IA
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Bombard Y, Veenstra G, Friedman JM, Creighton S, Currie L, Paulsen JS, Bottorff JL, Hayden MR. Perceptions of genetic discrimination among people at risk for Huntington's disease: a cross sectional survey. BMJ 2009; 338:b2175. [PMID: 19509425 PMCID: PMC2694258 DOI: 10.1136/bmj.b2175] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the nature and prevalence of genetic discrimination experienced by people at risk for Huntington's disease who had undergone genetic testing or remained untested. DESIGN Cross sectional, self reported survey. SETTING Seven genetics and movement disorders clinics servicing rural and urban communities in Canada. PARTICIPANTS 233 genetically tested and untested asymptomatic people at risk for Huntington's disease (response rate 80%): 167 underwent testing (83 had the Huntington's disease mutation, 84 did not) and 66 chose not to be tested. MAIN OUTCOME MEASURES Self reported experiences of genetic discrimination and related psychological distress based on family history or genetic test results. RESULTS Discrimination was reported by 93 respondents (39.9%). Reported experiences occurred most often in insurance (29.2%), family (15.5%), and social (12.4%) settings. There were few reports of discrimination in employment (6.9%), health care (8.6%), or public sector settings (3.9%). Although respondents who were aware that they carried the Huntington's disease mutation reported the highest levels of discrimination, participation in genetic testing was not associated with increased levels of genetic discrimination. Family history of Huntington's disease, rather than the result of genetic testing, was the main reason given for experiences of genetic discrimination. Psychological distress was associated with genetic discrimination (P<0.001). CONCLUSIONS Genetic discrimination was commonly reported by people at risk for Huntington's disease and was a source of psychological distress. Family history, and not genetic testing, was the major reason for genetic discrimination.
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Affiliation(s)
- Yvonne Bombard
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
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Baruch S, Hudson K. Civilian and military genetics: nondiscrimination policy in a post-GINA world. Am J Hum Genet 2008; 83:435-44. [PMID: 18940308 PMCID: PMC2561935 DOI: 10.1016/j.ajhg.2008.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Evidence is emerging of a growing societal consensus about appropriate and inappropriate uses of genetic information. The Genetic Information Nondiscrimination Act of 2008 provides new legal protections to Americans by prohibiting the discriminatory use of genetic information by health insurers and employers. Additionally, the United States military recently created new policies for fair use of genetic information in the determination of benefits for servicemen and servicewomen leaving military service. Although critical issues remain, such as the potential for genetic information to be used to deny people other forms of insurance, and how the military will use genetic medicine overall, significant progress has been made.
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Affiliation(s)
- Susannah Baruch
- The Genetics and Public Policy Center, 1717 Massachusetts Avenue, NW, Suite 530, Washington, DC 20036, USA.
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