1
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Friedman A, Anderson TL. Types of genetic determinism in direct-to-consumer genetic testing for health. Soc Sci Med 2024; 361:117376. [PMID: 39361998 DOI: 10.1016/j.socscimed.2024.117376] [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: 04/25/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 10/05/2024]
Abstract
Prior research has challenged genetic determinism by highlighting the complex ways lay people engage with genetics. However, most of these critiques took place prior to the availability of direct-to-consumer (DTC) genetic health testing and were based on reactions to genetic testing administered in a clinical context due to either symptoms or family history. Today, many lay people interact with genetic health information outside of medicine, and often without pre-existing symptoms or family history. This suggests the need to revisit genetic determinism in the context of this new mode of public engagement with genetic information about health. In this paper we examine how a sample of 39 people who had previously taken a DTC genetic test for health make sense of their results. We find genetic determinism is prominent, but takes on several distinct forms, including protective determinism, motivating determinism, and absolute determinism. Considering this, we argue that genetic determinism should not be treated as a singular or fixed concept and cannot be dismissed as insignificant, given its continued salience for DTC genetic test-takers. Our analysis also pays particular attention to how test-takers interpret negative results (i.e., no elevated risks detected), as this is a common outcome of DTC genetic tests but has not been a focus of prior research.
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Affiliation(s)
- Asia Friedman
- Department of Sociology and Criminal Justice, University of Delaware, USA.
| | - Tammy L Anderson
- Department of Sociology and Criminal Justice, University of Delaware, USA
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2
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Illusion of control in service failure situations: customer satisfaction/dissatisfaction, complaints, and behavioural intentions. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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3
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Zimmermann BM, Shaw DM, Elger B, Koné I. The use of heuristics in genetic testing decision-making: A qualitative interview study. PLoS One 2021; 16:e0260597. [PMID: 34847204 PMCID: PMC8631642 DOI: 10.1371/journal.pone.0260597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Decision-making concerning predictive genetic testing for hereditary cancer syndromes is inherently complex. This study aims to investigate what kind of complexities adults undergoing genetic counseling in Switzerland experience, how they deal with them, and what heuristics they use during the decision-making process. METHODS Semi-structured qualitative interviews with eighteen Swiss adults seeking genetic counseling for hereditary cancer syndrome genetic testing and two counseling physicians were conducted and analyzed using a grounded theory approach. RESULTS Counselees stated that once they were aware of their eligibility for genetic testing they perceived an inevitable necessity to make a decision in a context of uncertainties. Some counselees perceived this decision as simple, others as very complex. High emotional involvement increased perceived complexity. We observed six heuristics that counselees used to facilitate their decision: Anticipating the test result; Focusing on consequences; Dealing with information; Interpreting disease risk; Using external guidance; and (Re-)Considering the general uncertainty of life. LIMITATIONS Our findings are limited to the context of predictive genetic testing for hereditary cancer syndromes. This qualitative study does not allow extrapolation of the relative frequency of which heuristics occur. CONCLUSIONS The use of heuristics is an inherent part of decision-making, particularly in the complex context of genetic testing for inherited cancer predisposition. However, some heuristics increase the risk of misinterpretation or exaggerated external influences. This may negatively impact informed decision-making. Thus, this study illustrates the importance of genetic counselors and medical professionals being aware of these heuristics and the individual manner in which they might be applied in the context of genetic testing decision-making. Findings may offer practical support to achieve this, as they inductively focus on the counselees' perspective.
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Affiliation(s)
- Bettina Maria Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - David Martin Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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4
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Meagher KM, Curtis SH, Borucki S, Beck A, Srinivasan T, Cheema A, Sharp RR. Communicating unexpected pharmacogenomic results to biobank contributors: A focus group study. PATIENT EDUCATION AND COUNSELING 2021; 104:242-249. [PMID: 32919825 DOI: 10.1016/j.pec.2020.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/08/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The goals of this study were to explore 1) the impact of returning unexpected pharmacogenomic (PGx) results to biobank contributors, and 2) participant views about improving communication. METHODS We conducted a qualitative focus group study with biobank participants (N = 54) who were notified by mail of an individual research result indicating increased risk for adverse events associated with the common cancer drug 5-fluorouracil (5-FU). We employed a framework approach for analysis. RESULTS Our results revealed three themes illustrating participants' questions and uncertainty, especially regarding how to share results with health providers and family members, and remember them over time. Participants valued results for themselves and others, and for the future of medicine. Risk perception was framed by health identity. "Toxicity narratives," or familiarity with another's adverse reaction to chemotherapy, increased the sense of importance participants reported. CONCLUSION These focus group results highlight research participant remaining questions and high valuation of PGx results, even when unexpected. PRACTICE IMPLICATIONS We identify PGx research participants' needs for clear clinical translation messaging that attends to health identity, pragmatics of sharing information with family members, and patient perceptions of barriers to transferring research results to a clinical context.
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Affiliation(s)
- Karen M Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | - Susan H Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | | | - Annika Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | | | - Amal Cheema
- Geisel School of Medicine, Dartmouth College, Hanover, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA.
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5
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Ye F, He M, Huang L, Lang G, Hu X, Shao Z, Di G, Cao A. Insights Into the Impacts of BRCA Mutations on Clinicopathology and Management of Early-Onset Triple-Negative Breast Cancer. Front Oncol 2021; 10:574813. [PMID: 33505905 PMCID: PMC7829963 DOI: 10.3389/fonc.2020.574813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background Little is known regarding the clinicopathologic characteristics, oncologic outcomes, and treatment strategies that could be ascribed to BRCA mutation in early-onset triple-negative breast cancer (eTNBC). Methods eTNBC patients who underwent BRCA genetic testing were derived from our clinical database between 2012 and 2018. Differences in clinical features and pathologic characteristics were examined in groups divided by BRCA mutation status, and the contribution of germline mutations in conjunction with treatment modalities to survival outcomes was determined. Results Of the 355 qualifying eTNBC patients, 67 (18.87%) were BRCA mutated and 288 (81.13%) were BRCA wild. Overall, median age at diagnosis was 34 years (range, 24-40 years) in the BRCA mutated subgroup and 35 years (range, 21-40 years) in BRCA wild. The majority of clinicopathologic parameters were parallel; however, tumor size (P = 0.07) and nuclear grade (P =0.08) tend to be more aggressive in the BRCA mutated subgroup. Compared with BRCA wild patients, BRCA mutated patients had a higher likelihood of receiving anthracyclines and taxane-based combination chemotherapy (P = 0.04) and tend to be lower tumor burden (P =0.01). After approximately 5-year median follow-up, the overall survival (OS) (P = 0.021) and breast cancer-specific survival (BCSS) (P = 0.004) in BRCA mutated patients were superior to those in their BRCA wild counterparts. Intriguingly, the clinical outcomes were comparable in patients with breast conserving surgery (BCS) regardless of BRCA mutations and in patients with BRCA mutations in spite of surgical schedules. Conclusions These results suggest that eTNBC patients with BRCA mutations are prone to better OS and BCSS, which might be largely attributed to more benefit from anthracyclines and taxane-based chemotherapy. The BCS procedure could be a safe alternative surgical option for eTNBC patients with BRCA mutations. Future studies with substantial numbers of participants are urgently needed to validate whether BRCA mutation eTNBC patients are more sensitive to chemotherapy.
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Affiliation(s)
- Fugui Ye
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Min He
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Liang Huang
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guantian Lang
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Hu
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhimin Shao
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Genhong Di
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ayong Cao
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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6
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Gill G, Beard C, Storey K, Taylor S, Sexton A. "It wasn't just for me": Motivations and implications of genetic testing for women at a low risk of hereditary breast and ovarian cancer syndrome. Psychooncology 2020; 29:1303-1311. [PMID: 32497346 DOI: 10.1002/pon.5436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Genetic testing for hereditary breast and ovarian cancer (HBOC) due to pathogenic variants in BRCA1 or BRCA2 is why most women present to familial cancer centers. Despite being assessed as low risk for HBOC, many women proceed with genetic testing. This study explored the genetic testing experiences of unaffected women at low risk of HBOC to clarify what motivates these women to have testing, and what are the implications of the results. METHODS A qualitative approach was taken. Participants included women who had genetic testing for HBOC from 2016-2018 at the Parkville Familial Cancer Centre in Melbourne, Australia. In-depth, semi-structured interviews were conducted, and thematic analysis was undertaken on transcripts; transcripts were coded, codes were organized into a hierarchical system of categories/subcategories, and key themes were identified. RESULTS Analysis of 19 transcripts identified five themes: family underpinned all motivators for HBOC genetic testing; health professionals were influential throughout the process; participants were planning for a positive result; results influenced screening-anxiety and frequency; and negative results gave participants relief in many different ways. The three participants with positive results reported feeling shocked at the results and empowered giving this information to family members. CONCLUSIONS Women at low HBOC risk may be motivated to seek genetic testing, and access to this is increasingly offered through non-genetic health professionals. Professionals can support clients through genetic testing by recognizing familial experiences, providing accurate information, addressing risk perceptions, and understanding cancer anxiety felt by many women.
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Affiliation(s)
- Gulvir Gill
- Parkville Familial Cancer Centre and Genomic Medicine Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Beard
- Parkville Familial Cancer Centre and Genomic Medicine Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kirsty Storey
- Parkville Familial Cancer Centre and Genomic Medicine Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shelby Taylor
- Parkville Familial Cancer Centre and Genomic Medicine Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Adrienne Sexton
- Parkville Familial Cancer Centre and Genomic Medicine Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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7
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Minué-Lorenzo S, Fernández-Aguilar C, Martín-Martín JJ, Fernández-Ajuria A. [Effect of the use of heuristics on diagnostic error in Primary Care: Scoping review]. Aten Primaria 2020; 52:159-175. [PMID: 30711287 PMCID: PMC7063144 DOI: 10.1016/j.aprim.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/12/2018] [Accepted: 11/03/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of representativeness, availability, overconfidence, anchoring and adjustment heuristics in clinical practice, specifically in Primary Care setting. DESIGN Panoramic review (scope review). DATA SOURCES OvidMedline, Scopus, PsycoINFO, Cochrane Library and PubMed databases. Each one of the selected studies was reviewed applying TIDIER criteria (Template for Description of the Intervention and Replication) to facilitate their understanding and replicability. SELECTION OF STUDIES A total of 48 studies were selected that analyzed availability heuristics (26), anchoring and adjustment (9), overconfidence (9) and representativeness (8). RESULTS From the 48 studies selected, 26 analyzed availability heuristics, 9 anchoring and adjustment, 9 overconfidence; and 8 representativeness. The study population included physicians (35.4%), patients (27%), trainees (20.8%), nurses (14.5%) and students (14.5%). The studies conducted in clinical practice setting were 17 (35.4%). In 33 of the 48 studies (68,7%) it was observed heuristic use in the population studied. Heuristics use on diagnostic process was found in 27 studies (54.1%); 5 of them (18%) were carried out in clinical practice setting. Of the 48 studies, 6 (12,5%) were performed in Primary Care, 3 of which studied diagnostic process: only one of them analyzed the use of heuristics in clinical practice setting, without demonstrating bias as consequence of the use of heuristic. CONCLUSION The evidence about heuristic use in diagnostic process on clinical practice setting is limited, especially in Primary Care.
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Affiliation(s)
- Sergio Minué-Lorenzo
- Integrated Health Services based on Primary Health Care WHO Collaborating Centre. Escuela Andaluza de Salud Pública, Granada, España.
| | - Carmen Fernández-Aguilar
- Integrated Health Services based on Primary Health Care WHO Collaborating Centre. Escuela Andaluza de Salud Pública, Granada, España
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8
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Ross E. Researching Experiences of Cancer Risk Through Online Blogs: A Reflexive Account of Working Toward Ethical Practice. J Empir Res Hum Res Ethics 2020; 15:46-54. [PMID: 31423880 PMCID: PMC7049467 DOI: 10.1177/1556264619867840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
By providing space to document personal narratives and hold virtual discussions, the Internet represents a fruitful resource for sociologists of health and illness. However, the use of social media content for research entails complex ethical considerations. Due to the fluidity of online material, existing ethical guidelines advise a deliberative approach. However, this has led to disparity in the use of social media resources within the social sciences. I share an account of "doing ethics" for qualitative research with blogs focused on hereditary cancer risk. Blogging emerged not only as cathartic for authors, but also a means of accessing support. Blogs may thus be construed as constitutive and not only representative of cancer (risk) experience. Ethical questions surround anonymity and the appropriation of authors' accounts beyond the context in which they are composed. By sharing reflections on working with hereditary cancer risk blogs, I contribute to the continued reflexivity of social media researchers.
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Campbell-Salome G, Rauscher EA. Family storytelling about hereditary cancer: Framing shared understandings of risk. J Genet Couns 2020; 29:936-948. [PMID: 31970844 DOI: 10.1002/jgc4.1218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/06/2022]
Abstract
Family communication about the family's health history (FHH) is an important step in alerting individuals to their hereditary disease risks and facilitating prevention. Individuals often communicate about the FHH of hereditary cancer as a story, which highlights the importance of analyzing family narratives of hereditary cancer to better understand their relation to psychological and physical well-being. This study investigates the content of family stories by examining how narrative tone and framing relate to coping, perceptions of risk, and medical decision-making. The current study recruited 42 family dyads with a prevalent FHH of hereditary cancer to participate in dyadic phone interviews to jointly tell their family narrative of hereditary cancer. Using an iterative analysis, findings examine how families create a shared understanding of FHH and hereditary risk. Narrative tone reflects participants' psychological well-being and contributed to the way families framed their experiences. Common frames to family narratives of hereditary cancer included empowerment, adversity, laissez faire, and discrepant. Each frame gave insight into how families were coping, their perceptions of risk, and how they make medical decisions to manage those risks. Developing a better understanding of how families communicate about their hereditary cancer risks can aid in designing clinical interventions to help families re-frame their stories to promote improved health outcomes.
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Affiliation(s)
| | - Emily A Rauscher
- Department of Communication, University of Utah, Salt Lake City, UT, USA
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10
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Crimes D, Enticott G. Assessing the Social and Psychological Impacts of Endemic Animal Disease Amongst Farmers. Front Vet Sci 2019; 6:342. [PMID: 31637249 PMCID: PMC6787553 DOI: 10.3389/fvets.2019.00342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/20/2019] [Indexed: 12/04/2022] Open
Abstract
Outbreaks of exotic animal disease, such as Foot and Mouth Disease (FMD) are associated with social and psychological impacts amongst farmers. Whilst claims of similar impacts for endemic diseases have been made, there is little empirical evidence to justify these assertions. This paper provides a descriptive analysis of the social and psychological impacts of bovine Tuberculosis (bTB) in Wales. Specifically, the paper focuses on farmers subjective well-being and presenteeism—their propensity to work suboptimally when suffering mental health problems. Results from longitudinal qualitative interviews with 16 beef and dairy farmers reveal how they derive satisfaction from their work and their emotional connection to animals, whilst the weather and red tape are most likely to affect their quality of life. Data from a postal survey (n = 582) using three measures of SWB, however, finds mixed evidence that animal disease is associated with farmer well-being. For all farmers surveyed, there were no significant differences in well-being between farms with and without bTB. For those farms in areas with high bTB prevalence, two of the three measures of subjective well-being showed lower levels of well-being for farmers with a history of bTB (p < 0.05). In conclusion, the paper discusses the policy and methodological implications for future studies of farmer well-being and animal disease.
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Affiliation(s)
- Delyth Crimes
- School of Geography and Planning, College of Arts, Humanities and Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Gareth Enticott
- School of Geography and Planning, College of Arts, Humanities and Social Sciences, Cardiff University, Cardiff, United Kingdom
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11
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Scollon S, Majumder MA, Bergstrom K, Wang T, McGuire AL, Robinson JO, Gutierrez AM, Lee CH, Hilsenbeck SG, Plon SE, Parsons DW, Street RL. Exome sequencing disclosures in pediatric cancer care: Patterns of communication among oncologists, genetic counselors, and parents. PATIENT EDUCATION AND COUNSELING 2019; 102:680-686. [PMID: 30482469 PMCID: PMC6440863 DOI: 10.1016/j.pec.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/10/2018] [Accepted: 11/09/2018] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine communication patterns and behaviors during disclosure of exome sequencing (ES) results to parents of pediatric cancer patients, and describe common themes in parental communication. METHODS Using mixed methods, we analyzed transcripts of sessions where parents of pediatric cancer patients received ES results from an oncologist and genetic counselor. Seventy-six transcripts were analyzed for frequency of clinician information-giving, partnering-supportive talk, and active parent participation. A subset of 40 transcripts were analyzed using thematic content analysis. RESULTS Disclosures consisted mostly of clinician talk (84% of total talk), which was focused on providing information (62% of clinicians' utterances) with occasional partnering-supportive talk (7% of clinicians' utterances). Most parents assumed a passive, listening role (16% of total talk). Themes in parental communication included expressing relief and the significance of an answer, concern about sharing results and responsibility for inheritance, and seeking clarification of health implications of results. CONCLUSION Our finding of low levels of active parent participation during ES disclosures highlights the need to improve patient/parent engagement and understanding in a genetic setting. PRACTICE IMPLICATIONS Clinician communication strategies that could encourage parent participation and understanding include checking for parent understanding, partnership-building, and tailoring ES discussions to address parent concerns and preferences.
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Affiliation(s)
- Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310D, Houston, TX 77030, United States.
| | - Katie Bergstrom
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Tao Wang
- Dan L Duncan Cancer Center, Baylor College of Medicine, 6620 Main St., Houston, TX 77030, United States.
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310D, Houston, TX 77030, United States.
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310D, Houston, TX 77030, United States.
| | - Amanda M Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310D, Houston, TX 77030, United States.
| | - Caroline H Lee
- Rice University, 6100 Main St., Houston, TX 77005, United States.
| | - Susan G Hilsenbeck
- Dan L Duncan Cancer Center, Baylor College of Medicine, 6620 Main St., Houston, TX 77030, United States.
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Dan L Duncan Cancer Center, Baylor College of Medicine, 6620 Main St., Houston, TX 77030, United States.
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Richard L Street
- Department of Medicine, Baylor College of Medicine, 6620 Main St., Houston, TX 77030, United States; Department of Communication, Texas A&M University, TAMU 4234, College Station, TX 77843, United States; Center for Innovation in Healthcare Quality, Effectiveness, & Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX 77021, United States.
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Macdonald S, Conway E, Bikker A, Browne S, Robb K, Campbell C, Steele RJ, Weller D, Macleod U. Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal? Soc Sci Med 2019; 223:31-39. [PMID: 30703697 DOI: 10.1016/j.socscimed.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 01/22/2023]
Abstract
Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006-2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.
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Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elaine Conway
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Susan Browne
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robert Jc Steele
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
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13
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Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
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Shin E, Shim JM. Listen to Doctors, Friends, or Both? Embedded They Produce Thick Knowledge and Promote Health. JOURNAL OF HEALTH COMMUNICATION 2018; 24:9-20. [PMID: 30592700 DOI: 10.1080/10810730.2018.1554727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Do individuals gain from multiple sources of information that are often dissonant, such as expert knowledge and lay knowledge of health interventions? What are the foundations for any gain? For these questions, this paper investigates differences in the perceived health outcomes among the users of complementary and alternative medicine (CAM) who found their selection of CAM treatments on different knowledge bases. By using data from the 2012 US National Health Interview Survey (NHIS), the paper shows that CAM users report better health outcomes in the treatment episodes where they use CAM treatments that experts (i.e. health care professionals) or lay people (i.e. family/friends/co-workers) recommend, compared to those episodes where they use CAM treatments that nobody recommends. More interestingly, CAM users report even better health outcomes from the treatment episodes where they use CAM treatments that both professionals and family/friends/co-workers recommend, compared to those episodes where they use CAM treatments that only professionals or only family/friends/co-workers recommend. The paper conceptualizes these gains as emerging from users' mobilization of the thick knowledge that experts and lay people produce together. It stresses the importance of health communication where expert accounts and lay accounts are both paid heed.
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Affiliation(s)
- Eunjung Shin
- a Science and Technology Policy Institute , Sejong National Research Complex (Building B) , Sejong , Korea
| | - Jae-Mahn Shim
- b Department of Sociology , Korea University , Seoul , Korea
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15
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High-risk women's risk perception after receiving personalized polygenic breast cancer risk information. J Community Genet 2018; 10:197-206. [PMID: 30097836 DOI: 10.1007/s12687-018-0378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022] Open
Abstract
Evidence is accumulating of the clinical utility of single nucleotide polymorphisms to effectively stratify risk of breast cancer. Yet for this personalized polygenic information to be translated to clinical practice, consideration is needed about how this personalized risk information should be communicated and the impact on risk perception. This study examined the psychosocial implications and the impact on risk perception of communicating personalized polygenic breast cancer risk to high-risk women. High-risk women with a personal history of breast cancer and an uninformative BRCA1/2 result were genotyped in the Variants in Practice study for 22 breast cancer single nucleotide polymorphisms. Participants in the highest quartile of polygenic breast cancer risk were invited to receive their individual research results. Two personalized visual risk communication tools were used to facilitate communication of the polygenic information. Participants subsequently undertook a semi-structured interview examining their experience of receiving their polygenic breast cancer risk and their breast cancer risk perception. Thirty-nine women opted to receive their results and were interviewed. The women described the risk communication tools as helpful as the tool enabled comparison of their personalized breast cancer risk to the general population. Participants incorporated the polygenic risk information into their breast cancer risk perception, which for some reawakened feelings of being at risk years after an uninformative BRCA1/2 result. However, few reported any detrimental emotional impact. The delivery of personalized polygenic breast cancer risk to high-risk women informed and modified their breast cancer risk perception with little emotional impact.
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Ross E, Broer T, Kerr A, Cunningham-Burley S. Identity, community and care in online accounts of hereditary colorectal cancer syndrome. NEW GENETICS AND SOCIETY 2018; 37:117-136. [PMID: 29875617 PMCID: PMC5964445 DOI: 10.1080/14636778.2018.1469974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically "at risk" are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers' accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.
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Affiliation(s)
- Emily Ross
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Tineke Broer
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Anne Kerr
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Sarah Cunningham-Burley
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
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Moving In and Out of the What-Ifs: The Experiences of Unaffected Women Living in Families Where a Breast Cancer 1 or 2 Genetic Mutation Was Not Found. Cancer Nurs 2017; 40:386-393. [PMID: 27749355 DOI: 10.1097/ncc.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identified a deleterious mutation, the risk for hereditary breast cancer (HBC) can still be high when there is a strong family history. Little is known about how an awareness of risk for HBC impacts the everyday lives of unaffected women (no personal history for breast and/or ovarian cancer) in these families. OBJECTIVE The aim of this study is to explore how unaffected women, living in BRCA1/2-negative families, experience living with risk for HBC. METHODS van Manen's hermeneutic phenomenological approach guided this study. Unaffected at-risk women were recruited from a hereditary breast and ovarian cancer clinic in Western Canada. RESULTS Nine women participated in 20 open-ended conversations. Phenomenological reflection on the 4 life existentials (lived space, body, time, and relations) revealed "Moving In and Out of the What-Ifs" as an overarching description that was communicated through the following themes: "Just Moving Along: Living a Normal Life," "Moving Into Those Dark Spaces," "Is there Something Wrong With Me"? "Markings in Time," "Living in the Moment," "Being Cared For," and "Keeping Me Grounded." CONCLUSIONS The findings reveal how knowledge from predictive medicine impacts the lives of women and the importance of supportive relations and provides a foundation for future research into how health is perceived. IMPLICATIONS FOR PRACTICE The findings inform the practices of healthcare professionals as they engage in discussions with women living with risk for HBC and highlight the importance of a supportive relationship.
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Llewellyn R, Cunningham W, Jaye C, Young J, Egan R, Radue P. 'Why worry about something you can't control?' Negotiated risk, longevity and health behaviours. Health (London) 2017; 21:259-277. [PMID: 28521650 DOI: 10.1177/1363459317695869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While we know about lay attitudes towards death and dying, we understand little about the ways people estimate their overall personal risk of life-limiting disease and/or death. This study contributes to the limited literature on lay longevity reckonings, with a particular focus on how these reckonings may influence health behaviours. Semi-structured interviews were held with 21 young older adults (54-65 years), addressing the core questions of 'What do you think you will die from, and how long do you expect to live?' Participants indicated their longevity estimation was guided by three key frameworks: family history, environment and lifestyle factors and lived experience. The reckoning process was also moderated by assumptions about loci of control and self-efficacy and the information available to participants. A tripartite model of death risk assessment is proposed, extending the idea of 'negotiated risk' beyond the scope of family history where it has received most attention. We argue that by drawing on the three risk-assessment frameworks, determining patients' predisposition for external/internal attributions of control and perceptions of self-efficacy, clinicians will be better equipped to understand - and thus guide - patients' reckonings of longevity and health behaviours that are influenced by it.
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Affiliation(s)
| | - Wayne Cunningham
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
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Young JL, Werner-Lin A, Mueller R, Hoskins L, Epstein N, Greene MH. Longitudinal cancer risk management trajectories of BRCA1/2 mutation-positive reproductive-age women. J Psychosoc Oncol 2017; 35:393-408. [PMID: 28332940 DOI: 10.1080/07347332.2017.1292574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Young women with BRCA1/2 mutations face difficult health-care decisions regarding family formation, fertility, breastfeeding, and whether/when to undergo cancer risk-reducing surgery. This longitudinal qualitative study investigated these life choices during the reproductive years. We conducted two semistructured interviews over three years with 12 reproductive-age BRCA1/2-positive women. Researchers coded transcripts to examine the evolution of risk perceptions, risk management, and family planning decisions. To cope with the conflict between cancer risk reduction versus plans for pregnancy, breastfeeding, and child rearing, participants deliberately prioritized either risk reducing surgery or family formation goals. Implications for mutation carriers and health-care providers are outlined.
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Affiliation(s)
- Jennifer Louise Young
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA.,b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Allison Werner-Lin
- c School of Social Policy and Practice , University of Pennsylvania , Philadelphia , PA , USA
| | - Rebecca Mueller
- d School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA , USA
| | - Lindsey Hoskins
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
| | - Norman Epstein
- b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Mark H Greene
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
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Carrieri D, Farrimond H, Kelly S, Turnpenny P. Families dealing with the uncertainty of genetic disorders: the case of Neurofibromatosis Type 1. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:753-767. [PMID: 26864895 DOI: 10.1111/1467-9566.12401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Some scholars contend that genetic medicine is transforming the experience of illness and the social category of the family - bringing future risks into the present, and potentially strengthening familial biological bonds in light of these shared genetic risks. However, research has shown that genetic information is interpreted and acted upon through a rich repertoire of adaptable social, cultural and familial factors which pre-exist and interact with biomedical knowledge. This paper reports research into families living with Neurofibromatosis Type 1 (NF1), a highly uncertain condition the manifestation of which can vary considerably also within the same family and, for this reason, has been defined as a 'condition without parameters'. These characteristics make NF1 a particularly informative condition for the examination of family dynamics around genetic information. The study and the methodology are based on the exploration of family networks and allow us to investigate the interrelation of individual and familial constructions of the uncertainty of NF1. This also allows both theoretical and policy claims to be made about the danger of reductionist thinking about the transformative potential of genetic technologies.
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Affiliation(s)
- Daniele Carrieri
- Egenis, Department of Sociology, Philosophy and Anthropology, University of Exeter, UK
| | - Hannah Farrimond
- Egenis, Department of Sociology, Philosophy and Anthropology, University of Exeter, UK
| | - Susan Kelly
- Egenis, Department of Sociology, Philosophy and Anthropology, University of Exeter, UK
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Hesse-Biber S, An C. Genetic Testing and Post-Testing Decision Making among BRCA-Positive Mutation Women: A Psychosocial Approach. J Genet Couns 2016; 25:978-92. [PMID: 26758254 DOI: 10.1007/s10897-015-9929-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
Abstract
Through an analysis of an online survey of women who tested positive for the BRCA genetic mutation for breast cancer, this research uses a social constructionist and feminist standpoint lens to understand the decision-making process that leads BRCA-positive women to choose genetic testing. Additionally, this research examines how they socially construct and understand their risk for developing breast cancer, as well as which treatment options they undergo post-testing. BRCA-positive women re-frame their statistical medical risk for developing cancer and their post-testing treatment choices through a broad psychosocial context of engagement that also includes their social networks. Important psychosocial factors drive women's medical decisions, such as individual feelings of guilt and vulnerability, and the degree of perceived social support. Women who felt guilty and fearful that they might pass the BRCA gene to their children were more likely to undergo risk reducing surgery. Women with at least one daughter and women without children were more inclined toward the risk reducing surgery compared to those with only sons. These psychosocial factors and social network engagements serve as a "nexus of decision making" that does not, for the most part, mirror the medical assessments of statistical odds for hereditary cancer development, nor the specific treatment protocols outlined by the medical establishment.
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Affiliation(s)
- Sharlene Hesse-Biber
- Department of Sociology, Boston College, McGuinn Hall 419, 140 Commonwealth Avenue, Chestnut Hill, Boston, MA, 02467, USA.
| | - Chen An
- Department of Educational Research, Measurement, and Evaluation, Boston College, Chestnut Hill, Boston, MA, USA
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22
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Anderson M, Asnani M. 'The white blood cell always eat the red': how Jamaicans with sickle cell disease understand their illness. ETHNICITY & HEALTH 2015; 21:103-117. [PMID: 25833758 DOI: 10.1080/13557858.2015.1028522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore lay understandings of sickle cell disease (SCD) among Jamaicans living with the illness. There is no qualitative research on this subject in Jamaica, where SCD is the most common genetic disorder. DESIGN Thirty in-depth semi-structured interviews (50% males, 50% urban residence) were conducted with adult patients attending the Sickle Cell Unit in Jamaica. Transcribed data were analysed using thematic analysis. RESULTS Patients' narratives focused on two main themes: lay understandings of how SCD works (using ideas of attack and fortification, and blockage and flow); and what causes the illness (lay ideas of inheritance). The most common description of SCD was that their white blood cells were 'eating/sucking out/feeding on' their red blood cells. Hence, treatment required 'building up' their blood, while a key to good health was ensuring an unimpeded flow of blood. Most participants believed SCD was hereditary, but there were various understandings of the mechanism and probability of its transmission. Belief in the possibility of transmitting SCD was not always a barrier to reproduction, nor did participants always insist on their partner or child being tested. CONCLUSIONS Participants engaged in medical pluralism, a dynamic combination of folk and biomedical beliefs. Their concerns, experiences and interpretations were powerful motivators of reproductive and screening behaviour. Their narratives of SCD transcend the individual to express social, societal and cultural realities. Health care professionals and policy-makers should communicate clearly to ensure understanding, and recognize and engage with their patients' sociocultural context.
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Affiliation(s)
- Moji Anderson
- a a Department of Sociology, Psychology and Social Work , University of the West Indies , Kingston , Jamaica
| | - Monika Asnani
- b b Sickle Cell Unit, Tropical Medicine Research Institute , University of the West Indies , Kingston , Jamaica
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El-Toukhy S. Parsing susceptibility and severity dimensions of health risk perceptions. JOURNAL OF HEALTH COMMUNICATION 2015; 20:499-511. [PMID: 25749555 DOI: 10.1080/10810730.2014.989342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Risk perceptions, an important determinant of positive behavioral change, are often conceptualized as an additive or multiplicative index of two concepts: susceptibility to and severity of a health risk. Susceptibility is the possibility of experiencing a health risk, whereas severity is its seriousness or harmfulness. This article challenged the current theorization of risk perceptions. To demonstrate the differential perceptions of susceptibility and severity, two self-report studies (N = 70, each) and one reaction time study (N = 476) provided data on 50 health conditions that varied on several risk characteristics (e.g., prevalence, personal experience). Results showed that susceptibility and severity were two distinct, inversely related concepts. Perceived susceptibility and severity varied by risk characteristics, mainly prevalence (i.e., how common a health risk was perceived to be). Self-report data showed that a progressive increase in perceptions of a health risk prevalence rates was associated with an increase in susceptibility and a decrease in severity (and vice versa). Reaction-time data mirrored this pattern and showed these differential perceptions of susceptibility and severity were highly accessible, as evident by fast reaction times. Several individual differences (e.g., optimism) emerged as significant predictors of risk perceptions and their accessibility. Theoretical and practical implications are discussed.
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Affiliation(s)
- Sherine El-Toukhy
- a Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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24
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Manuel A, Brunger F. "Awakening to" a new meaning of being at-risk for arrhythmogenic right ventricular cardiomyopathy: a grounded theory study. J Community Genet 2015; 6:167-75. [PMID: 25620752 DOI: 10.1007/s12687-015-0212-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022] Open
Abstract
Efforts of social scientists to understand how individuals living in a family at risk for a genetically linked condition make health care decisions, having brought to the forefront the contextual nature of risk perception. Using a grounded theory approach, this study examines the experiences of 29 individuals living in families at risk for arrhythmogenic right ventricular cardiomyopathy (ARVC). Attention is paid to how individuals (re)construct the meaning of being at risk in relation to the developing science of gene discovery. Findings highlight that individuals living in a family at risk for ARVC juxtapose existing scientific knowledge against experiential knowledge as they "awaken to" the fact that they or a family member are at risk. This process is pragmatic and fluid and contingent upon whether and how symptoms are aligned with the constructed image of the at-risk relative.
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Affiliation(s)
- April Manuel
- Memorial University, St. John's, Newfoundland and Labrador, Canada,
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25
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Yamasaki J, Hovick SR. "That was grown folks' business": narrative reflection and response in older adults' family health history communication. HEALTH COMMUNICATION 2015; 30:221-30. [PMID: 24580636 DOI: 10.1080/10410236.2013.837569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Given the importance of family health history and the pivotal role of older adults in communicating it, this study examines how African American older adults (a) characterize their understandings of health-related conditions in their family histories and (b) rationalize their motivations and constraints for sharing this information with current family members. Using narrative theory as a framework, we illustrate how the participants reflect on prior health-related experiences within the family to respond to moral and practical calls for communicating family health information to current relatives. Specifically, our analysis highlights how storied family secrets--as constructed by 28 participants in group and individual interviews--reveal and inform shifting cultural and generational practices that shape the lived health behaviors and communication of older adults at greater risk for health disparities.
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Affiliation(s)
- Jill Yamasaki
- a Valenti School of Communication , University of Houston
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26
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Clinicopathologic characteristics of breast cancer in BRCA-carriers and non-carriers in women 35 years of age or less. Breast 2014; 23:770-4. [PMID: 25231195 DOI: 10.1016/j.breast.2014.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Breast cancer diagnosed in women 35 years of age or less accounts for <2% of all breast cancer cases. Clinical and pathologic characteristics of early onset breast cancer are not well defined in BRCA mutation carriers and non-carriers. METHODS 194 women diagnosed with breast cancer at 35 years of age or less who had BRCA1/2 mutation testing were included in the study. Logistic regression models were fit to determine the associations between clinical variables and BRCA status. RESULTS Thirty-two (17%) and 12 (6%) patients had BRCA1 and BRCA2 mutations, respectively. BRCA1-carriers had a higher likelihood of a positive family history (FH) of breast and/or ovarian cancer (P = 0.001), or first-degree relatives diagnosed with breast cancer at <50 years old (P = 0.001) compared to non-carriers. BRCA2-carriers were more likely to have a FH of male breast cancer compared to noncarriers (P = 0.02). Among BRCA2-carriers, the age at first full-term pregnancy was younger in ER-negative cases compared with ERpositive cases (19.5 vs. 28.5 years old; P = 0.01). BRCA1-carriers with a later age at menarche were more likely to have a later stage at diagnosis (P = 0.04). Non-carriers with a lower BMI were more likely to have lymph node involvement (P = 0.03). CONCLUSIONS Several associations were identified between reproductive risk factors or BMI and disease characteristics. Further characterization may result in a better understanding of the trends in young onset breast cancer in BRCA-carriers and non-carriers.
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Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making 2014; 35:539-57. [PMID: 25145577 DOI: 10.1177/0272989x14547740] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 07/26/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. METHOD Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. RESULTS Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. CONCLUSIONS Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.
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Affiliation(s)
- J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX (JSBB)
| | - Heather Krieger
- Department of Social Psychology, University of Houston, Houston, TX (HK)
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28
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Jeffers L, Morrison PJ, McCaughan E, Fitzsimons D. Maximising survival: the main concern of women with hereditary breast and ovarian cancer who undergo genetic testing for BRCA1/2. Eur J Oncol Nurs 2014; 18:411-8. [PMID: 24731853 DOI: 10.1016/j.ejon.2014.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE Little is known about how women with hereditary breast and/or ovarian cancer who test positive for a BRCA gene manage the impact of a positive test result on their everyday lives and in the longer term. This study defined the experience and needs of women with hereditary breast and ovarian cancer and a positive BRCA test over time. METHODS A grounded theory approach was taken using qualitative interviews (n = 49) and reflective diaries. Data collected from December 2006 until March 2010 was analysed using the constant comparative technique to trace the development of how women manage their concerns of inherited cancer. RESULTS A four stage substantive theory of maximising survival was generated that defines the experience of women and how they resolve their main concerns. The process of maximising survival begins prior to genetic testing in women from high risk families as they expect to get a cancer diagnosis at some time. Women with cancer felt they had experienced the worst with a cancer diagnosis and altruistically tested for the sake of their children but a positive test result temporarily shifted their focus to decision-making around their personal health needs. CONCLUSION This study adds to clinical practice through raising awareness and adding insights into how women cope with living with inherited cancer risk and the personal and familial ramifications that ensue from it. A clear multi-professional structured care pathway for women from genetic testing result disclosure to undergoing risk-reducing surgery and/or surveillance should be developed.
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Affiliation(s)
- Lisa Jeffers
- Belfast Health and Social Care Trust, Department of Genetics, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK.
| | - Patrick J Morrison
- Belfast Health and Social Care Trust, Department of Genetics, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK
| | - Eilis McCaughan
- Institute of Nursing Research, University of Ulster, Coleraine BT52 1SA, UK
| | - Donna Fitzsimons
- Institute of Nursing Research, University of Ulster, Jordanstown BT37 0QB, UK; Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK
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Donnelly LS, Evans DG, Wiseman J, Fox J, Greenhalgh R, Affen J, Juraskova I, Stavrinos P, Dawe S, Cuzick J, Howell A. Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic. Br J Cancer 2014; 110:1681-7. [PMID: 24594998 PMCID: PMC3974072 DOI: 10.1038/bjc.2014.109] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews. METHODS All eligible women between 33 and 46 years at ≥17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews. RESULTS Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk. CONCLUSIONS Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.
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Affiliation(s)
- L S Donnelly
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - D G Evans
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Genomic Medicine, MAHSC, St Mary's Hospital, Manchester M13 9WL, UK
| | - J Wiseman
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Fox
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - R Greenhalgh
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Affen
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - P Stavrinos
- Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester M23 9LT, UK
| | - S Dawe
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - A Howell
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK
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Fisher CL, Maloney E, Glogowski E, Hurley K, Edgerson S, Lichtenthal WG, Kissane D, Bylund C. Talking about familial breast cancer risk: topics and strategies to enhance mother-daughter interactions. QUALITATIVE HEALTH RESEARCH 2014; 24:517-535. [PMID: 24633365 DOI: 10.1177/1049732314524638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A hereditary cancer predisposition can rattle families, creating dysfunctional interactions. Families need assistance navigating conversations about risk. Because mothers and daughters uniquely share breast cancer experiences and risk, there is a particular need for practitioners to assist them with communication. Three focus groups were conducted with 11 mothers with an elevated cancer risk (with adolescent daughters) receiving genetic counseling. We explored three inquiries to capture mother-daughter communication: emergent challenging topics (e.g., health-promotion behavior, daughter's risk, mother's risk of death), factors complicating discussions (e.g., balancing what to share and when, guilt and blaming, confusion about risk and prevention), and strategies enhancing conversations initiated by mothers (e.g., paying attention to daughter's cues) or practitioners (e.g., inviting daughters to appointments). Findings suggested that mothers struggle to balance eliciting daughters' concerns, providing them with support, and imparting knowledge without overwhelming them. We offer mothers and practitioners guidance to help facilitate these conversations.
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Crowdsourcing awareness: exploration of the ovarian cancer knowledge gap through Amazon Mechanical Turk. PLoS One 2014; 9:e85508. [PMID: 24465580 PMCID: PMC3899016 DOI: 10.1371/journal.pone.0085508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background Ovarian cancer is the most lethal gynecologic disease in the United States, with more women dying from this cancer than all gynecological cancers combined. Ovarian cancer has been termed the “silent killer” because some patients do not show clear symptoms at an early stage. Currently, there is a lack of approved and effective early diagnostic tools for ovarian cancer. There is also an apparent severe knowledge gap of ovarian cancer in general and of its indicative symptoms among both public and many health professionals. These factors have significantly contributed to the late stage diagnosis of most ovarian cancer patients (63% are diagnosed at Stage III or above), where the 5-year survival rate is less than 30%. The paucity of knowledge concerning ovarian cancer in the United States is unknown. Methods The present investigation examined current public awareness and knowledge about ovarian cancer. The study implemented design strategies to develop an unbiased survey with quality control measures, including the modern application of multiple statistical analyses. The survey assessed a reasonable proxy of the US population by crowdsourcing participants through the online task marketplace Amazon Mechanical Turk, at a highly condensed rate of cost and time compared to traditional recruitment methods. Conclusion Knowledge of ovarian cancer was compared to that of breast cancer using repeated measures, bias control and other quality control measures in the survey design. Analyses included multinomial logistic regression and categorical data analysis procedures such as correspondence analysis, among other statistics. We confirmed the relatively poor public knowledge of ovarian cancer among the US population. The simple, yet novel design should set an example for designing surveys to obtain quality data via Amazon Mechanical Turk with the associated analyses.
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Hovick SR. Understanding family health information seeking: a test of the theory of motivated information management. JOURNAL OF HEALTH COMMUNICATION 2014; 19:6-23. [PMID: 24117214 DOI: 10.1080/10810730.2013.778369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Although a family health history can be used to assess disease risk and increase health prevention behaviors, research suggests that few people have collected family health information. Guided by the Theory of Motivated Information Management, this study seeks to understand the barriers to and facilitators of interpersonal information seeking about family health history. Individuals who were engaged to be married (N = 306) were surveyed online and in person to understand how factors such as uncertainty, expectations for an information search, efficacy, and anxiety influence decisions and strategies for obtaining family health histories. The results supported the Theory of Motivated Information Management by demonstrating that individuals who experienced uncertainty discrepancies regarding family heath history had greater intention to seek information from family members when anxiety was low, outcome expectancy was high, and communication efficacy was positive. Although raising uncertainty about family health history may be an effective tool for health communicators to increase communication among family members, low-anxiety situations may be optimal for information seeking. Health communication messages must also build confidence in people's ability to communicate with family to obtain the needed health information.
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Affiliation(s)
- Shelly R Hovick
- a School of Communication , The Ohio State University , Columbus , Ohio , USA
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Balmer C, Griffiths F, Dunn J. A qualitative systematic review exploring lay understanding of cancer by adults without a cancer diagnosis. J Adv Nurs 2013; 70:1688-701. [DOI: 10.1111/jan.12342] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Claire Balmer
- Warwick Clinical Trials Unit; University of Warwick Medical School; Coventry UK
| | | | - Janet Dunn
- Health Sciences; University of Warwick Medical School; Coventry UK
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Living my family's story: identifying the lived experience in healthy women at risk for hereditary breast cancer. Cancer Nurs 2013; 35:493-504. [PMID: 22544165 DOI: 10.1097/ncc.0b013e31824530fa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Based on known or suggested genetic risk factors, a growing number of women now live with knowledge of a potential cancer diagnosis that may never occur. Given this, it is important to understand the meaning of living with high risk for hereditary breast cancer. OBJECTIVE The objective of the study was to explore how women at high risk for hereditary breast cancer (1) form self-identity, (2) apply self-care strategies toward risk, and (3) describe the meaning of care through a high-risk breast program. METHODS Interpretive hermeneutic phenomenology guided the qualitative research method. Women at high risk for hereditary breast cancer were recruited from a high-risk breast program. Open-ended interview questions focused on experiences living as women managing high risk for breast cancer. Consistent with hermeneutic methodology, the principal investigator led a team to analyze the interview transcripts. RESULTS Twenty women participated in in-depth interviews. Analysis revealed that women describe their own identity based on their family story and grieve over actual and potential familial loss. This experience influences self-care strategies, including seeking care from hereditary breast cancer risk experts for early detection and prevention, as well as maintaining a connection for early treatment "when" diagnosis occurs. CONCLUSIONS Healthy women living with high risk for hereditary breast cancer are living within the context of their family cancer story, which influences how they define themselves and engage in self-care. IMPLICATIONS FOR PRACTICE Findings present important practical, research, and policy information regarding health promotion, psychosocial assessment, and support for women living with hereditary breast cancer risk.
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Macrae L, de Souza AN, Loiselle CG, Wong N. Experience of BRCA1/2 mutation-negative young women from families with hereditary breast and ovarian cancer: a qualitative study. Hered Cancer Clin Pract 2013; 11:14. [PMID: 24131499 PMCID: PMC3829374 DOI: 10.1186/1897-4287-11-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 08/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the experience of young women who become aware of their parent's BRCA1 or BRCA2 (BRCA) mutation status as adolescents or young adults. There is also currently a gap in the literature pertaining to those who are found to be negative for their familial mutation. We aimed to investigate the experience of these mutation-negative young women from hereditary breast and ovarian cancer (HBOC) families. METHODS Using a semi-structured questionnaire we interviewed 8 women. All of the women were non-carriers of their familial mutation and had learned of the mutation in their family as adolescents or young adults at least 6 months prior to undergoing genetic testing. All interviews were audio recorded, transcribed, and independently analyzed by the investigators. This was followed by an in-depth cross-case analysis, enabling the formulation of emergent themes. RESULTS The women's age ranged from 22 to 37 years old and all were of Ashkenazi Jewish descent. Prominent emergent themes from the interviews included the impact of how and when the familial mutation status was disclosed, the factors influencing when a young woman chooses to undergo predictive genetic testing, the predictors of post-test adjustment and risk perception, as well as the impact of familial cancer experience versus the familial mutation. CONCLUSIONS By eliciting detailed patient narratives we have begun to show that this generation of BRCA mutation-negative young women is likely still affected by the degree of cancer history in their family, even with their understanding of the genetic contribution to disease. Larger studies with tightened participant characteristics, as well as studies involving women from different cultural backgrounds, are needed to further define the experience and needs of true negative young women from HBOC families.
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Affiliation(s)
- Lynn Macrae
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Department of Medical Genetics, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Carmen G Loiselle
- Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada
- School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Nora Wong
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Department of Medical Genetics, Jewish General Hospital, Montreal, Quebec, Canada
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Watkins KE, Way CY, Gregory DM, LeDrew HM, Ludlow VC, Esplen MJ, Dowden JJ, Cox JE, Fitzgerald GWN, Parfrey PS. Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale. BMC Psychol 2013; 1:7. [PMID: 25566359 PMCID: PMC4270033 DOI: 10.1186/2050-7283-1-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/06/2013] [Indexed: 11/20/2022] Open
Abstract
Background The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments. Furthermore, we have limited insight into the role of the family in promoting adjustment. Methods The purpose of this study was to develop and initially validate the Psychosocial Adjustment to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated from a qualitative data base and tested in a sample of 243 participants from families with LS. Results The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the psychometric properties of the PAHD. The findings support the convergent and discriminant validity of the subscales. Construct validity was confirmed by factor analysis and Cronbach’s alpha supported a strong internal consistency for BK (0.83) and FC (0.84). Conclusion Preliminary testing suggests that the PAHD is a psychometrically sound scale capable of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable monitoring tool to identify individuals and families who may require therapeutic interventions.
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Affiliation(s)
- Kathy E Watkins
- Centre for Nursing Studies, Eastern Regional Integrated Health Authority, St. John's, NL Canada ; Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Christine Y Way
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; School of Nursing, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; Eastern Regional Integrated Health Authority, St. John's, NL Canada
| | - Holly M LeDrew
- Western Regional School of Nursing, Western Regional Integrated Health Authority, Corner Brook, NL Canada
| | - Valerie C Ludlow
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Jeffrey J Dowden
- Newfoundland and Labrador Centre for Health Information, St. John's, NL Canada
| | - Janet E Cox
- Division of Surgery, Charles S. Curtis Memorial Hospital, St. Anthony, NL Canada
| | | | - Patrick S Parfrey
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
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Mendes Á, Sousa L. Families' experience of oncogenetic counselling: accounts from a heterogeneous hereditary cancer risk population. Fam Cancer 2012; 11:291-306. [PMID: 22367452 DOI: 10.1007/s10689-012-9514-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This paper reports the results of semi-structured family interviews conducted with a purposive sample of nine families (comprising 50 individuals) involved in cancer genetic counselling at a Portuguese public hospital. Qualitative analysis resulted in thematic categories illustrating: (1) how families go through cancer genetic counselling (eliciting risk awareness, the motivators, risk management, the psychosocial context of familial engagement in genetic counselling, and the familial pathways of cancer risk tracking); and (2) how families incorporate genetic risk into family life (strategies for family resilience, and the meanings and values that permeate the experience). Families have recognised the value of genetic counselling in enabling participants to take measures to confront disease risk; however, the experience was dominated by distressing feelings. A set of ethical-relational principles guided the experience. Familial experiences on genetic counselling and tracking of cancer susceptibility encompass a sense of trajectory that takes the form of an historical and intergenerational narrative process, linking past, present and possible futures. Such process implies an ongoing set of individual and interactional experiences taking place over time. Specific changes associated with the illness timeline and with individual and family developmental lifespan transitions are thus acknowledged. These results may help genetics healthcare practitioners understand how families perceive, respond to and accommodate cancer risk counselling, and thus illuminate family-oriented tenets for planning and practice.
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Affiliation(s)
- Álvaro Mendes
- Health, Family and Community Research Group, Department of Health Sciences, University of Aveiro, University Campus of Santiago, 3810-093, Aveiro, Portugal.
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Vos J, Menko FH, Oosterwijk JC, van Asperen CJ, Stiggelbout AM, Tibben A. Genetic counseling does not fulfill the counselees' need for certainty in hereditary breast/ovarian cancer families: an explorative assessment. Psychooncology 2012; 22:1167-76. [PMID: 22777929 DOI: 10.1002/pon.3125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/30/2012] [Accepted: 05/30/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many cancer-patients undergo DNA testing in the BRCA1/2 genes to receive information about the likelihood that cancer is heritable. Previous nonsystematic studies suggested that DNA testing often does not fulfill the counselees' needs for certainty. We explored the balance between the counselees' need for certainty and perceived certainty (NfC-PC, i.e., level of fulfillment of NfC) regarding the specific domains of DNA test result, heredity and cancer. We also examined relationships of NfC-PC with coping styles and distress. METHOD Before disclosure of BRCA1/2 test results for hereditary breast/ovarian cancer (T1), questionnaires were filled in by 467 cancer-patients. Another questionnaire (T2) was filled in after disclosure of pathogenic mutation results (n = 30), uninformative results (n = 202) or unclassified-variants (n = 16). RESULTS Before and after DNA test result disclosure, overall 58-94% of all counselees experienced unfulfilled NfC regarding the DNA test result, heredity and cancer. Compared with T1, the communication of pathogenic mutations (T2) caused more fulfillment of the NfC about the DNA test result, but less about cancer and heredity (p < .01). Compared with T1, unclassified variants (T2) did not significantly change the extent of fulfillment of all counselees' needs for certainty (NfC > PC). Compared with T1, uninformative results (T2) caused more fulfillments of all needs than before disclosure (p < 0.01). Counselees differentiated NfC and PC between the domains of DNA-test result, heredity and cancer (p < 0.01). The unfulfilled needs for certainty (NfC-PC) were uncorrelated with cognitive understanding of the DNA test result. CONCLUSION The counselees' NfC needs more attention in research and practice, for example, when the potential uncertainties of testing are discussed. The counselees' NfC may be assessed and used in tailored, mutual communication of DNA test results.
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Affiliation(s)
- Joël Vos
- Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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A counselee-oriented perspective on risk communication in genetic counseling: explaining the inaccuracy of the counselees' risk perception shortly after BRCA1/2 test result disclosure. Genet Med 2012; 13:800-11. [PMID: 21885922 DOI: 10.1097/gim.0b013e31821a36f9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Genetic counseling may help counselees understand their genetic risk of developing breast/ovarian cancer. However, many studies have shown that their perception of their risks is inaccurate. Information-oriented variables often predicted the level of accuracy, focusing on specific processes of receiving and processing risks. We examined counselee-oriented predictors about how counselees embed cancer risks in their lives. These predictors reflect the personal meaning of genetic risks and are expected to explain/mediate the impact of genetic counseling on risk-perception-accuracy. METHOD We analyzed 248 questionnaires of a prospective study, filled in by probands with breast/ovarian cancer and pathogenic mutations, unclassified variants, or uninformative results (n = 30, 16, and 202, respectively). Mediation regression analyses were performed to examine whether counselee predictors mediated/explained the influence of information predictors on the accuracy. Information-oriented predictors regarded presentation format, communicated information, question format, education, pedigree information, cancer experience, and cognitive processes/heuristics. Counselee-oriented predictors regarded their self/personality, life/existence, and need for certainty about DNA test result, heredity, and cancer. RESULTS Both information-oriented and counselee-oriented variables significantly predicted the accuracy of the counselees' risk perception, with moderate to large effect sizes. Counselee-oriented variables completely mediated/explained the effects of information-oriented variables on the accuracy. DISCUSSION Counselees seemed to transform objective cancer risks into personally relevant information. Only through this personal meaning of genetic information, information-oriented processes seemed to cause inaccurate perceptions. Genetic counselors are suggested to focus communication on these personal processes.
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Mendes A, Paneque M, Sousa L. Are family-oriented interventions in Portuguese genetics services a remote possibility? Professionals' views on a multifamily intervention for cancer susceptibility families. J Community Genet 2012; 3:311-8. [PMID: 22314708 DOI: 10.1007/s12687-012-0079-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 01/20/2012] [Indexed: 11/24/2022] Open
Abstract
This article examines genetics healthcare professionals' opinions about a multifamily psychoeducational programme for hereditary cancer susceptibility families, implemented at a Portuguese genetics service. Their views on how a family-oriented approach is envisioned to be incorporated in Portuguese genetic counselling services are also reported. Six focus groups and three individual interviews were undertaken comprising 30 professionals working in the provision of genetic counselling and genetic counsellor trainees. Participants were given a page-summary describing the intervention and asked to comment the strengths and limitations of the multifamily intervention. All interviews were fully transcribed and analysed using the constant comparison method. The qualitative analysis generated data comprising four thematic categories in relation to the professionals' views: (a) usefulness of the programme; (b) programme's methodological and practical obstacles; (c) genetics services constraints; and (d) suggestions for improving the programme and further family-oriented interventions. We reflect on the reported views examining the intervention, and on how current constraints of genetic services limit the provision of psychosocial support for cancer susceptibility families. The implications of these findings regarding the purpose of genetic counselling are discussed. Results may sensitise stakeholders and policy makers for the need to deliver family-based services in cancer genetic counselling, with adequate planning and collaborative involvement of different professionals.
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Affiliation(s)
- Alvaro Mendes
- Health, Family and Community Research Group, Department of Health Sciences, University of Aveiro, University Campus of Santiago, 3810-093, Aveiro, Portugal,
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Paneque M, Sequeiros J, Skirton H. Quality assessment of genetic counseling process in the context of presymptomatic testing for late-onset disorders: a thematic analysis of three review articles. Genet Test Mol Biomarkers 2011; 16:36-45. [PMID: 21819246 DOI: 10.1089/gtmb.2011.0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Presymptomatic testing (PST) is available for a range of late-onset disorders. Health practitioners generally follow guidelines regarding appropriate number of counseling sessions, involvement of multidisciplinary teams, topics for pretest discussion, and follow-up sessions; however, more understanding is needed about what helps consultands effectively and the impact of amount and quality of genetic counseling on the psychosocial sequelae of PST for late-onset disorders. We conducted a thematic analysis of three review articles on quality of the genetic counseling process, aiming at (1) exploring current evidence; (2) identifying quality assessment indicators; and (3) making recommendations for genetic counseling practice in late-onset disorders. We undertook a systematic search of 6 relevant databases: 38 articles were identified and 3 fitted our inclusion criteria; after quality appraisal, all were included in the review. The number of sessions, time spent, consultation environment, follow-up, and multidisciplinarity were identified as variables for quality assessment. Research on counseling in the context of genetic testing in familial cancer tends to be related to outcomes and indicators for quality assessment, while research concerning other late-onset diseases is mainly focused on the psychological impact of the test results. The quality and content of the overall process in noncancer late-onset diseases is insufficiently articulated. Despite the fact that PST for Huntington disease and other degenerative conditions has been offered for more than 20 years, good methodological approaches to assess quality of genetic counseling in that context remain elusive. This restricts improvement of the protocols for genetic services and, in general, healthcare for the at-risk population.
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Affiliation(s)
- Milena Paneque
- Center for Predictive and Preventive Genetics-CGPP, Institute for Molecular and Cell Biology-IBMC, ICBAS, University of Porto, Porto, Portugal.
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Vos J, Menko F, Jansen AM, van Asperen CJ, Stiggelbout AM, Tibben A. A whisper-game perspective on the family communication of DNA-test results: a retrospective study on the communication process of BRCA1/2-test results between proband and relatives. Fam Cancer 2011; 10:87-96. [PMID: 20852944 PMCID: PMC3036814 DOI: 10.1007/s10689-010-9385-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective of this paper is to study how DNA-test result information was communicated and perceived within families. A retrospective descriptive study in 13 probands with a BRCA1/2 unclassified variant, 7 with a pathogenic mutation, 5 with an uninformative result, and in 44, 14, and 12 of their 1st and 2nd degree relatives respectively. We examined differences and correlations between: (a) information actually communicated (b) probands' perception, (c) relatives' perception. The perception consisted of recollections and interpretations of both their own and their relatives' cancer-risks, and heredity-likelihood (i.e. likelihood that cancer is heritable in the family). Differences and low correlations suggested few similarities between the actually communicated information, the probands' and the relatives' perception. More specifically, probands recalled the communicated information differently compared with the actually communicated information (R = .40), and reinterpreted this information differently (R = .30). The relatives' perception was best correlated with the proband's interpretation (R = .08), but this perception differed significantly from their proband's perception. Finally, relatives reinterpreted the information they received from their proband differently (R = .25), and this interpretation was only slightly related with the original message communicated by the genetic-counsellor (R = .15). Unclassified-variants were most frequently misinterpreted by probands and relatives, and had the largest differences between probands' and relatives' perceptions. Like in a children's whisper-game, many errors occur in the transmission of DNA-test result information in families. More attention is required for how probands disseminate information to relatives. Genetic-counsellors may help by supporting the probands in communicating to relatives, e.g. by providing clear summary letters for relatives.
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Affiliation(s)
- Joël Vos
- Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
This review of family communication of genetic risk information addresses questions of what the functions and influences on communication are; what, who and how family members are told about genetic risk information; what the impact for counsellee, relative and relationships are; whether there are differences by gender and condition; and what theories and methodologies are used. A systematic search strategy identified peer-reviewed journal articles published 1985-2009 using a mixture of methodologies. A Narrative Synthesis was used to extract and summarise data relevant to the research questions. This review identified 33 articles which found a consistent pattern of findings that communication about genetic risk within families is influenced by individual beliefs about the desirability of communicating genetic risk and by closeness of relationships within the family. None of the studies directly investigated the impact of communication on counsellees or their families, differences according to gender of counsellee or by condition nor alternative methods of communication with relatives. The findings mainly apply to late onset conditions such as Hereditary Breast and Ovarian Cancer. The most frequently used theory was Family Systems Theory and methods were generally qualitative. This review points to multifactorial influences on who is communicated with in families and what they are told about genetic risk information. Further research is required to investigate the impact of genetic risk information on family systems and differences between genders and conditions.
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Abstract
Continued advances in genetics and genomics research suggest that more and more people will be identified ‘at risk’ for common diseases such as cancer, heart disease or diabetes. A perspective for understanding how people adapt to and manage inherited risk, as well as identifying differences in individual response to DNA information would be useful in the planning and provision of genetics health services. This article adopts a ‘chronic risk’ perspective to explore living at risk of Huntington disease (HD), a fatal genetic disorder. Qualitative data analysis suggested two broad themes that illustrated living with chronic risk: (1) biographical disruption, including threats to self-identity and changes to relationships with others; and (2) zones of relevance, the conditions under which risk is or is not salient. Findings are relevant to the provision of genetics health services, particularly in follow-up support to individuals at risk for HD and their families.
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Ersig AL, Ayres L, Hadley DW, Koehly LM. Explanations of risk in families without identified mutations for hereditary nonpolyposis colorectal cancer. J Nurs Scholarsh 2010; 42:139-46. [PMID: 20618598 DOI: 10.1111/j.1547-5069.2010.01342.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Genetic testing for hereditary forms of cancer does not always identify a causative mutation. Little is known about personal or family response to these indeterminate results when a hereditary form of cancer is suspected. This study explored thoughts about and responses to risk for hereditary nonpolyposis colorectal cancer (HNPCC) when a family member has received indeterminate genetic test results. DESIGN In this qualitative study, data were gathered from index cases who received indeterminate genetic test results through a longitudinal study offering genetic counseling and testing for HNPCC. First-degree relatives of these indeterminate index cases were also invited to participate in the qualitative interview. METHODS Semistructured telephone interviews were conducted with index cases and their at-risk first-degree relatives. Data were analyzed using the within- and across-case method. FINDINGS The across-case analysis led to the development of the Awareness and Surveillance Trajectory, which describes individual interpretations of and responses to risk, based on personal and family history. Explanations of risk addressed the meaning of cancer in the family and provided context for individual interpretations. They were identified using within-case analysis and organized into a typology: innate, exceptional, idiosyncratic, and undeveloped explanations. CONCLUSIONS Members of families without identified HNPCC mutations vary in their explanations for, interpretations of, and responses to indeterminate genetic test results. CLINICAL RELEVANCE Explanations of family risk and interpretations of individual risk offer healthcare providers valuable information. In combination with the Awareness and Surveillance Trajectory, assessment of these beliefs can facilitate development of individualized recommendations and strategies for possible preventive actions.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, University of Iowa, Iowa City, IA 52242, USA.
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Bekker HL. The loss of reason in patient decision aid research: do checklists damage the quality of informed choice interventions? PATIENT EDUCATION AND COUNSELING 2010; 78:357-364. [PMID: 20171821 DOI: 10.1016/j.pec.2010.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 01/14/2010] [Accepted: 01/17/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To discuss whether using the International Patient Decision Aids Standards (IPDAS) Collaboration checklist as a gold standard to judge interventions' quality is premature and potentially detrimental to the validity of resources designed to help patients make treatment choices. METHODS Conceptual review integrating the science behind individuals' decision making with the demands of designing complex, healthcare interventions. RESULTS Patient decision aids are promoted as interventions to help professionals engage in shared and/or patient-centred care. The IPDAS domains were informed by experts' opinions of best practice. Decision scientists study how individuals make decisions, what biases their choices and how best to support decisions. There is debate from decision scientists about which component parts are the active ingredients that help people make decisions. CONCLUSIONS Interventions to help patients make choices have different purposes, component parts and outcomes to those facilitating professional-patient communications. The IPDAS checklist will change to respond to new evidence from the decision sciences. PRACTICE IMPLICATIONS Adhering uncritically to the IPDAS checklist may reduce service variation but is not sufficient to ensure interventions enable good patient decision making. Developers must be encouraged to reason about the IPDAS checklist to identify those component parts that do (not) meet their intervention's purpose.
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Affiliation(s)
- Hilary L Bekker
- Research About Patients Informed Decisions (R.A.P.I.D.) Group, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
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Abstract
Genetic testing for adult-onset diseases is now available. One such test is for the mutations present in the BRCA gene that result in a significantly higher risk for the development of breast cancer or ovarian cancer. Women who have one of these mutations face difficult choices in terms of increased surveillance or prophylactic surgeries. Examining experiences of women with BRCA mutations can serve as an exemplar for other populations at risk for genetically associated adult-onset diseases.
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Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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The effect of BRCA gene testing on family relationships: A thematic analysis of qualitative interviews. J Genet Couns 2009; 18:418-35. [PMID: 19479365 DOI: 10.1007/s10897-009-9232-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/23/2009] [Indexed: 12/13/2022]
Abstract
Discovery of mutations in the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 can have emotional consequences for both the tested individual and his or her relatives. This secondary analysis study investigated how BRCA testing impacts family dynamics and relationships. For the original study, a grounded theory inquiry, participants were recruited from a hereditary breast/ovarian cancer syndrome support website and open-ended interviews were performed asking about individual and family experiences after BRCA testing. All 12 participants whose interviews were included in the secondary analysis had a BRCA mutation. For the secondary analysis, thematic analysis was conducted and revealed three main themes characterizing the effect of BRCA testing on family relationships: 1. That the first in the family to have testing or seek genetic counseling takes on a special family role that can be difficult for them; 2. That discussions in the family often change; and 3. That individuals may feel more or less connected to certain family members. These changes seemed to relate to family cancer history, relationships, coping strategies, communication patterns, and mutation status. Genetic counselors might find it useful to explore these issues in order to prepare clients before BRCA testing and to support them through shifts in family dynamics after disclosure of results.
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