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Foil K, Christon L, Kerrigan C, Flume PA, Drinkwater J, Szentpetery S. Experiences of cystic fibrosis newborn screening and genetic counseling. J Community Genet 2023; 14:621-626. [PMID: 37656403 PMCID: PMC10725400 DOI: 10.1007/s12687-023-00666-8] [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: 03/14/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
The South Carolina cystic fibrosis (CF) newborn screening (NBS) program changed in 2019 to include CFTR genotyping for babies with top 4% immunoreactive trypsinogen, which improves sensitivity and timeliness but increases carrier detection. Carrier identification has genetic implications for the family and parents of NBS+ babies have increased emotional distress. Genetic counseling (GC) may increase parent understanding and reduce anxiety yet is not uniformly offered at CF centers. We report our early results after implementing GC for NBS+ families at the time of sweat chloride testing based on GC availability, which resulted in an unselected GC- control arm. Sixteen mothers (GC+ = 9, GC- = 7) participated in an online survey about their experience. Responses were analyzed in aggregate and for differences between GC+ and GC- groups. All-respondent sadness and anxiety increased with notification of the NBS+ result and decreased after sweat test results. Anxiety and sadness were greater in GC- compared to GC+ until after the diagnosis was resolved, though emotional differences between the groups were not statistically significant. On a scale of 0 = not at all to 10 = extremely, GC was rated very helpful (mean 9.0, range 5-10), informative (mean 8.9, range 4-10), comforting (mean 9.1, range 6-10), and minimally distracting (mean 1.8, range 0-9). All participants correctly identified that a risk for a child to have CF exists when both parents are (at least) carriers. Delivery of NBS results to respondents varied by timing, informant, and information given. The child's pediatrician notified 10 (62.5%) of the NBS+ result. Parents felt they were notified in a timely manner (68.8%), by someone knowledgeable about NBS (62.5%), the sweat test (62.5%), CF (43.8%), and genetics (43.8%) and who cared about them (81.3%). Parents felt worried (81.3%), confused (81.3%), empowered (25%), and other (sad, shocked, scared, overwhelmed, devastated, defeated). Data from this single-center study suggest benefit of GC, that families would value earlier contact with an expert, and that prompt diagnostic resolution may reduce duration of parental distress.
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Affiliation(s)
- Kimberly Foil
- Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive Room 113, Charleston, SC, 29425, USA.
| | - Lillian Christon
- Department Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cheryl Kerrigan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive Room 113, Charleston, SC, 29425, USA
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Jaclyn Drinkwater
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Sylvia Szentpetery
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Yang L, Lin Z, Gao Y, Zhang J, Peng H, Li Y, Che J, Zhao L, Zhang J. Populational pan-ethnic screening panel enabled by deep whole genome sequencing. NPJ Genom Med 2023; 8:38. [PMID: 37985665 PMCID: PMC10661700 DOI: 10.1038/s41525-023-00383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Birth defect is a global threat to the public health systems. Mitigating neonatal anomalies is hampered by elusive molecular mechanisms of pathogenic mutations and poor subsequent translation into preventative measures. Applying appropriate strategies in China to promote reproductive health is particularly challenging, as the Chinese population compromises complex genomic diversity due to the inclusion of many ethnic groups with distinct genetic backgrounds. To investigate and evaluate the feasibility of implementing a pan-ethnic screening strategy, and guide future reproductive counselling, high-quality variants associated with autosome recessive (AR) diseases derived from the largest publicly available cohort of the Chinese population were re-analysed using a bottom-up approach. The analyses of gene carrier rates (GCRs) across distinct ethnic groups revealed that substantial heterogeneity existed potentially due to diverse evolutionary selection. The sampling population, sequencing coverage and underlying population structure contributed to the differential variants observed between ChinaMAP and the East Asian group in gnomAD. Beyond characteristics of GCR, potential druggable targets were additionally explored according to genomic features and functional roles of investigated genes, demonstrating that phase separation could be a therapeutic target for autosomal recessive diseases. A further examination of estimated GCR across ethnic groups indicated that most genes shared by at least two populations could be utilised to direct the design of a pan-ethnic screening application once sequencing and interpreting costs become negligible. To this end, a list of autosomal recessive disease genes is proposed based on the prioritised rank of GCR to formulate a tiered screening strategy.
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Affiliation(s)
- Linfeng Yang
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, BGI-Shijiazhuang Medical Laboratory, Shijiazhuang, China
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Zhe Lin
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, BGI-Shijiazhuang Medical Laboratory, Shijiazhuang, China
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Yong Gao
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, BGI-Shijiazhuang Medical Laboratory, Shijiazhuang, China
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Jianguo Zhang
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, BGI-Shijiazhuang Medical Laboratory, Shijiazhuang, China
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | | | - Yaqing Li
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | | | - Lijian Zhao
- BGI Genomics, BGI-Shenzhen, Shenzhen, China.
- Medical Technology College of Hebei Medical University, Shijiazhuang, China.
| | - Jilin Zhang
- Tung Biomedical Sciences Centre, City University of Hong Kong, Hong Kong S.A.R, China.
- Department of Precision Diagnostic and Therapeutic Technology, The City University of Hong Kong Shenzhen Futian Research Institute, Shenzhen, China.
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong S.A.R, China.
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Best S, Long JC, Fehlberg Z, Taylor N, Ellis LA, Boggs K, Braithwaite J. Using a theory informed approach to design, execute, and evaluate implementation strategies to support offering reproductive genetic carrier screening in Australia. BMC Health Serv Res 2023; 23:1276. [PMID: 37981708 PMCID: PMC10658900 DOI: 10.1186/s12913-023-10053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/23/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Health care professionals play a central role in offering reproductive genetic carrier screening but face challenges when integrating the offer into practice. The aim of this study was to design, execute, and evaluate theory-informed implementation strategies to support health care professionals in offering carrier screening. METHODS An exploratory multi-method approach was systematically employed based on the Theoretical Domain Framework (TDF). Implementation strategies were designed by aligning TDF barriers reported by health care professionals involved in a large carrier screening study, to behaviour change techniques combined with study genetic counsellors' experiential knowledge. The strategies were trialled with a subset of health care professionals and evaluated against controls, using findings from questionnaires and interviews with healthcare professionals. The primary outcome measure was the number of couples who initiated enrolment. RESULTS Health care professionals (n = 151) reported barriers in the TDF Domains of skills, e.g., lack of practice in offering screening, and challenges of environmental context and resources, e.g., lack of time, which informed the design of a skills video and a waiting room poster using the TDF-behaviour change technique linking tool. Following implementation, (Skills video n = 29 vs control n = 31 and Poster n = 46 vs control n = 34) TDF barrier scores decreased across all groups and little change was observed in the primary outcome measure. The skills video, though welcomed by health care professionals, was reportedly too long at seven minutes. The waiting room poster was seen as easily implementable. CONCLUSIONS As carrier screening moves towards mainstream healthcare, health care professionals report barriers to offering screening. To meet their needs, developing and testing experiential and theory-informed strategies that acknowledge contextual factors are essential.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia.
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Janet C Long
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Zoe Fehlberg
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Natalie Taylor
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Kirsten Boggs
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Clinical Genetics, Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
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Best S, Long JC, Fehlberg Z, Archibald AD, Braithwaite J. Supporting healthcare professionals to offer reproductive genetic carrier screening: a behaviour change theory approach. Aust J Prim Health 2023; 29:480-489. [PMID: 37156638 DOI: 10.1071/py23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND As reproductive genetic carrier screening (RGCS) becomes more widely accessible, ensuring uptake by primary healthcare professionals (HCPs) is essential to equitable service provision. This study aimed to identify and prioritise implementation strategies to reduce barriers and support HCPs to routinely offer RGCS in Australia. METHODS HCPs (n =990) involved in a large national research study, offering couples-based RGCS, were surveyed at three time points: prior to offering RGCS through the study (Survey 1: Barriers); 8+weeks after offering to their patients (Survey 2: Possible supports); and towards the end of the study (Survey 3: Prioritised supports). HCPs were from primary care (e.g. general practice, midwifery) and tertiary care (e.g. fertility, genetics) settings. Results were analysed via a novel approach of using behaviour change theory (Capability, Opportunity and Motivation - COM.B) to align theory to practice. RESULTS Survey 1 (n =599) identified four barrier themes: time constraints, lack of HCP knowledge and skill, patient receptivity, and HCP's perceived value of RGCS. Survey 2 (n =358) identified 31 supports that could facilitate HCPs offering RGCS. Survey 3 (n =390) was analysed separately by speciality and clinic location. Prioritised supports for primary care HCPs were 'regular continuing professional development activities' and 'a comprehensive website to direct patients for information'. There was general accordance with the perceived importance of the supports, although some difference in relation to funding between professional groups and clinic locations. CONCLUSION This study identified a range of supports acceptable to HCPs across specialties and geographic locations that policymakers may use to direct efforts to ensure the roll out of RGCS is equitable across Australia.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia; and Australian Genomics, Murdoch Children's Research Institute, Melbourne, Vic. 3052, Australia; and Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia; and Victorian Comprehensive Cancer Centre Alliance, Melbourne, Vic. 3000, Australia; and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic. 3000, Australia
| | - Janet C Long
- Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia
| | - Zoe Fehlberg
- Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia; and Australian Genomics, Murdoch Children's Research Institute, Melbourne, Vic. 3052, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Melbourne, Vic. 3000, Australia; and Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Vic. 3052, Australia; and Genomics in Society, Murdoch Children's Research Institute, Melbourne, Vic. 3052, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia
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The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission): Design and Implementation. J Pers Med 2022; 12:jpm12111781. [PMID: 36579509 PMCID: PMC9698511 DOI: 10.3390/jpm12111781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) provides people with information about their chance of having children with autosomal recessive or X-linked genetic conditions, enabling informed reproductive decision-making. RGCS is recommended to be offered to all couples during preconception or in early pregnancy. However, cost and a lack of awareness may prevent access. To address this, the Australian Government funded Mackenzie’s Mission—the Australian Reproductive Genetic Carrier Screening Project. Mackenzie’s Mission aims to assess the acceptability and feasibility of an easily accessible RGCS program, provided free of charge to the participant. In study Phase 1, implementation needs were mapped, and key study elements were developed. In Phase 2, RGCS is being offered by healthcare providers educated by the study team. Reproductive couples who provide consent are screened for over 1200 genes associated with >750 serious, childhood-onset genetic conditions. Those with an increased chance result are provided comprehensive genetic counseling support. Reproductive couples, recruiting healthcare providers, and study team members are also invited to complete surveys and/or interviews. In Phase 3, a mixed-methods analysis will be undertaken to assess the program outcomes, psychosocial implications and implementation considerations alongside an ongoing bioethical analysis and a health economic evaluation. Findings will inform the implementation of an ethically robust RGCS program.
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