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Forrest LE, Forbes Shepherd R, Tutty E, Pearce A, Campbell I, Devereux L, Trainer AH, James PA, Young MA. The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study. J Pers Med 2022; 12:jpm12071112. [PMID: 35887609 PMCID: PMC9315752 DOI: 10.3390/jpm12071112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research identifying and returning clinically actionable germline variants offer a new avenue of access to genetic information. The psychosocial and clinical outcomes for women who have received this ‘genome-first care’ delivering hereditary breast and ovarian cancer risk information outside of clinical genetics services are unknown. Methods: An exploratory sequential mixed-methods case-control study compared outcomes between women who did (cases; group 1) and did not (controls; group 2) receive clinically actionable genetic information from a research cohort in Victoria, Australia. Participants completed an online survey examining cancer risk perception and worry, and group 1 also completed distress and adaptation measures. Group 1 participants subsequently completed a semi structured interview. Results: Forty-five participants (group 1) and 96 (group 2) completed the online survey, and 31 group 1 participants were interviewed. There were no demographic differences between groups 1 and 2, although more of group 1 participants had children (p = 0.03). Group 1 reported significantly higher breast cancer risk perception (p < 0.001) compared to group 2, and higher cancer worry than group 2 (p < 0.001). Some group 1 participants described how receiving their genetic information heightened their cancer risk perception and exacerbated their cancer worry while waiting for risk-reducing surgery. Group 1 participants reported a MICRA mean score of 27.4 (SD 11.8, range 9−56; possible range 0−95), and an adaptation score of 2.9 (SD = 1.1). Conclusion: There were no adverse psychological outcomes amongst women who received clinically actionable germline information through a model of ‘genome-first’ care compared to those who did not. These findings support the return of clinically actionable research results to research participants.
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Affiliation(s)
- Laura E. Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.F.); (R.F.S.); (E.T.); (A.H.T.); (P.A.J.)
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia; (I.C.); (L.D.)
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.F.); (R.F.S.); (E.T.); (A.H.T.); (P.A.J.)
| | - Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.F.); (R.F.S.); (E.T.); (A.H.T.); (P.A.J.)
| | - Angela Pearce
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia;
| | - Ian Campbell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia; (I.C.); (L.D.)
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Lisa Devereux
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia; (I.C.); (L.D.)
- Lifepool, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Alison H. Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.F.); (R.F.S.); (E.T.); (A.H.T.); (P.A.J.)
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia; (I.C.); (L.D.)
| | - Paul A. James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.F.); (R.F.S.); (E.T.); (A.H.T.); (P.A.J.)
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia; (I.C.); (L.D.)
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia;
- Correspondence:
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