Genetic screening and genetic counseling: knowledge, attitudes, and practices in two groups of family planning professionals

Premarital screening programmes for haemoglobinopathies, HIV and hepatitis viruses: review and factors affecting their success

This literature review is a comprehensive summary of premarital (prenuptial) screening programmes for the most prevalent hereditary haemoglobinopathies, namely thalassaemia and sickle cell disease, and the important infections HIV (human immunodeficiency virus) and hepatitis viruses B and C (HBV and HCV). It describes the background to premarital screening programmes and their value in countries where these diseases are endemic. The use of premarital screening worldwide is critically evaluated, including recent experiences in Saudi Arabia, followed by discussion of the outcomes of such programmes. Despite its many benefits, premarital testing is not acceptable in some communities for various legal and religious reasons, and other educational and cultural factors may prevent some married couples following the advice given by counsellors. The success of these programmes therefore depends on adequate religious support, government policy, education and counselling. In contrast to premarital screening for haemoglobinopathies, premarital screening for HIV and the hepatitis viruses is still highly controversial, both in terms of ethics and cost-effectiveness. In wealthy countries, premarital hepatitis and HIV testing could become mandatory if at-risk, high-prevalence populations are clearly identified and all ethical issues are adequately addressed.

Primary care physicians' utilization and perceptions of genetics services

PURPOSE

To document primary care physicians' utilization and perceptions of genetics services.

METHODS

A randomized survey of physicians in the Pacific Northwest.

RESULTS

The greatest factor prompting a genetics referral was the patient's interest in the evaluation, and the most common reason not to obtain a consultation was the perception that it was of no benefit to the patient. Genetics consultation was rarely sought for a family history of cancer or for deafness, polycystic kidney disease, or congenital heart disease. Even when uncertain about relative risk, physicians usually counseled a patient themselves rather than referring to a specialist.

CONCLUSION

Primary care physicians need more education about the genetic component of many diseases to provide directly and to refer appropriately for genetics services.

Evaluation of a project to enhance knowledge of hereditary diseases and management

During 1992 and 1993, in a designated suburban area of Perth, Western Australia, information on hereditary disease was provided for health professionals and the general community. This information was in the form of posters, pamphlets, postal flyers and return letter cards, a static display, newspaper articles, advertisements and radio broadcasts, and professional seminars. The aim of this project was to evaluate the effectiveness of combined strategies to convey practical information about hereditary disease to the community and health professionals. Multiple measures of response evaluation were used, which included structured questionnaire surveys of health professionals and members of the community before and after the project. In the community surveys, respondents who were female, married, middle aged, and parents, and had a higher level of education or were born in Australia, New Zealand, or the United Kingdom were generally better informed about hereditary diseases. This intervention resulted in only meagre changes in community knowledge about hereditary disease, even though promotional materials were shown to be appropriate. General Practitioners (GPs) and Child Health Nurses (CHNs) were supportive of clinical genetic services and recognised a need for continuation of education in this field. There is a rapidly increasing need for community and health professional comprehension of the applications of the new genetic technology. This project indicates that routine educational and health promotion strategies will not be enough to achieve desired levels of knowledge and attitude change.

Health visitors' awareness and perception of clinical genetic services

A questionnaire was sent to 84 health visitors to assess their awareness and perception of genetic services and how they perceived their role in the referral of patients. The study showed that while health visitors had a reasonable knowledge of the more obvious aspects of genetic services, there were a number of areas in which they were unsure. The respondents did not identify themselves as prime initiators in the process of referring patients to a genetic service, although they appeared able to identify families on their caseloads for whom this service may be relevant. Health visitors viewed their own knowledge of genetics as poor, a factor which may account for the low referral rate initiated by this group of professionals. The respondents attached importance to genetic issues and 76 (95%) wished to be better informed about the subject. It is suggested that the inclusion of genetics as part of an in-service training programme might fulfil this need and lead to greater advocacy of genetic services among the families in their care. These findings are of interest in view of the proposals within the recent Royal College of Physicians report (Prenatal screening and genetic counselling) suggesting that community genetic services should make use of primary health care workers such as health visitors.

Acceptance of genetic services: a study of physicians in Colombo, Sri Lanka

A survey of 302 physicians from Colombo, Sri Lanka, reveals a strong overall acceptance of genetic counselling, prenatal diagnosis of genetic disorders and therapeutic abortion. Demographic and experiential factors, especially being older and having children, were associated with acceptance of genetic services. There was little support for prenatal diagnosis in order to satisfy curiosity about the sex of the fetus. The results of this analysis were compared to those from a study of physicians in Arizona, USA.

The public, the primary physician, and genetic counselling

This article reviews the literature regarding variables that affect that likelihood that genetic counselling will be either requested by clients or suggested by primary care practitioners. Results of current research indicate that use of genetic counselling may be hindered by a lack of knowledge on the part of both physicians and the public, by such psychological barriers as fear of genetic disease and its attendant stigma, by cultural values that stress reliance on fate or God's will, by medical values that deemphasize clients' emotional needs and disease prevention and that stress active intervention by the physician, and by financial consideration. The findings suggest the need for research on 1) knowledge of and attitudes toward genetic disease, genetic counselling, and genetic screening among the general public, 2) variables affecting the public's response to genetic counselling and genetic screening programs in different socio-demographic communities, and 3) physicians' value systems and their effects on physicians' use of genetic counselling.

Stigmatization of carrier status: social implications of heterozygote genetic screening programs

Possible latent psychological and social consequences ensuing from genetic screening programs need to be investigated during the planning phase of national genetic screening programs. The relatively few studies which have been performed to determine psychological, social, and economic consequences resulting from a genetic screening program are reviewed. Stigmatization of carrier-status, having major psychosocial implications in heterozygote genetic screening programs, is discussed and related to Erving Goffman's work in the area of stigmatization. Questions are raised regarding the relationship between such variables as religiosity and sex of the individual and acceptance of the status of newly identified carrier of a mutant gene. Severity of the deleterious gene and visibility of the carrier status are two important factors to consider in an estimation of potential stigma. Specific implications are discussed for four genetic diseases: Tay-Sachs, Sickle-Cell Anemia, Huntington's disease and Hemophilia.