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Oliveira CR, Seidi C, Sequeiros J, Sousa L, Mendes Á. Health-related roles of older generations in families with inherited genetic conditions: a scoping review. J Community Genet 2024:10.1007/s12687-024-00713-y. [PMID: 38795255 DOI: 10.1007/s12687-024-00713-y] [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: 11/23/2023] [Accepted: 05/20/2024] [Indexed: 05/27/2024] Open
Abstract
Inherited genetic conditions are family diseases. They affect consanguineous relatives, in lineage for several generations, and impact the family dynamics. Older generations have been considered highly influential in the health management of families with inherited genetic conditions. To our knowledge, no reviews so far addressed the health-related roles of older generations in these families. This scoping review aims to fill that gap by mapping the existent research about the health-roles roles performed by the older generations in families living with autosomal dominant inherited genetic conditions. Four electronic databases were searched: Scopus, Web of Science, PubMed, PsycInfo. Eleven studies were included, and relevant findings were extracted. Main roles included: informers vs. blockers of disease-related information; encouragers vs. discouragers of health screening or genetic testing; (non-)supporters; and role models in living and coping with the disease. The roles played by older generations are relevant to the health management of other family members and can be beneficial to themselves (reciprocal interactions). Acknowledging and understanding these roles is important for professionals and health-services. Results suggest the relevance of an intergenerational perspective when working with families with inherited genetic conditions.
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Affiliation(s)
- Carla Roma Oliveira
- Associação dos Lares Ferroviários, Entroncamento, Portugal.
- CINTESIS@RISE, Department of Education and Psychology, Universidade de Aveiro, Aveiro, Portugal.
- CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - Catarina Seidi
- CINTESIS@RISE, Department of Education and Psychology, Universidade de Aveiro, Aveiro, Portugal
- CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jorge Sequeiros
- CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
| | - Liliana Sousa
- CINTESIS@RISE, Department of Education and Psychology, Universidade de Aveiro, Aveiro, Portugal
| | - Álvaro Mendes
- CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Koehly LM, Manalel JA. Interconnected social convoys: Understanding health and well-being through linked personal networks. ADVANCES IN LIFE COURSE RESEARCH 2023; 56:100541. [PMID: 38054886 DOI: 10.1016/j.alcr.2023.100541] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 12/07/2023]
Abstract
The convoy model of social relations describes how social relationships contribute to an individual's health and well-being from a life course and lifespan perspective. In large part, this model focuses on the unique, personal experiences of an individual, without due consideration of the reciprocal and shared relationships among those whose lives are inextricably linked. Here, we extend the convoy model to directly integrate Elder's concept of linked lives by considering the composition, structure, and function of linked personal networks, or social convoys, among close others, and the important implications of these network characteristics on the health of all involved. We illustrate this extension within the context of family, one of the most pivotal social contexts that can shape an individual's life course. Features of interconnected social convoys can help improve our understanding of how social ties shape and are shaped by life events not just for individuals, but for larger units of inquiry - such as, couples, parent-child triads, and nuclear families. Importantly, the interconnected convoy includes both family and non-family ties, providing a framework that considers how peoples' social spheres are linked as they jointly experience shared situations. Using informal caregiving as an example, we highlight the advantages that interconnected convoys bring to the concept of linked lives and provide direction on how this framework can advance our understanding of how social relationships influence either directly or indirectly health and well-being of individuals and families across the life course.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-2073, USA.
| | - Jasmine A Manalel
- Brookdale Center for Healthy Aging, Hunter College, New York, NY 10035, USA
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Zhao J, Guan Y, McBride CM. A systematic review of theory-informed strategies used in interventions fostering family genetic risk communication. PATIENT EDUCATION AND COUNSELING 2022; 105:1953-1962. [PMID: 35304074 PMCID: PMC9203975 DOI: 10.1016/j.pec.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Inherited risk is a family issue. Identifying family members who carry a pathogenic genetic variant that increases risk of cancers and other chronic diseases can be lifesaving for those affected. OBJECTIVE The research questions are: (1) which family communication frameworks have been applied, (2) how do intervention strategies employed map to these theories, and (3) to what extent were families receptive to these strategies and communication increased? METHODS Manuscripts published between January 2010 and August 2020 were searched in three databases: PubMed, PsycINFO, and Web of Science. RESULTS Nine intervention trials were identified. All interventions were evaluated in clinical genetic counseling contexts using at least one individual-level strategy (e.g. increase knowledge). Only three focused on dyadic conversations such as preparing for relatives' information needs. CONCLUSIONS This systematic review posed the question whether theoretically based approaches have been applied to foster family genetic risk communication. Greater attention needs to be paid to the utilization of dyadic level and family system level theories to guide intervention developments. PRACTICAL IMPLICATIONS We conclude by calling for accelerating and broadening the development of interventions to enable family communication about inherited risk that are theory-based, incorporate family-systems thinking, and are conducted outside of specialty clinic settings.
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Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
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From older to younger generations: Intergenerational transmission of health-related roles in families with Huntington's disease. J Aging Stud 2022; 61:101027. [DOI: 10.1016/j.jaging.2022.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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Kristensen MS, Thygesen LC, Tay DL, Kumar R, Grønvold M, Aldridge M, Ornstein KA. Size and composition of family networks of decedents: A nationwide register-based study. Palliat Med 2021; 35:1652-1662. [PMID: 33823696 DOI: 10.1177/0269216321998602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. AIM To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. DESIGN A cross-sectional population-level study with data collected from nation-wide registers. SETTING/PARTICIPANTS All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. RESULTS Among 175,755 decedents (median age: 68 years, range: 18-81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. CONCLUSIONS While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery.
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Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Raj Kumar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mogens Grønvold
- Department of Public Health, University of Copenhagen, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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"Being proactive, not reactive": exploring perceptions of genetic testing among White, Latinx, and Pacific Islander Populations. J Community Genet 2021; 12:617-630. [PMID: 34415555 DOI: 10.1007/s12687-021-00542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 07/25/2021] [Indexed: 12/20/2022] Open
Abstract
Genetic testing is becoming an integral part of healthcare, but evidence suggests that both race and ethnicity influence access to and utilization of genetic testing. Given this barrier, data are needed on the perceptions of genetic testing in racial and ethnic minority groups. The purpose of this study was to explore the perceptions of three types of genetic testing (genetic testing for adult-onset conditions, prenatal screening, and newborn screening) in a sample of US participants who identified as White, Pacific Islander, and Latinx (10 dyads from each group for 60 participants total). Data were collected through semi-structured dyadic interviews and assessed using thematic analysis. The major themes were knowledge as empowering, knowledge as stressful, and predictive nature of prenatal testing and newborn screening. Some differences were seen in themes by race and ethnicity. A sense of collective and familial health appeared to be a more important theme for Pacific Islander and Latinx participants compared to White participants. Adult-onset genetic testing was viewed variously across all groups with some noting how it may increase anxiety, particularly if the disease screened for was unable to be prevented with action. All three groups reported on the positives of prenatal testing and newborn screening yet often were confused on the differences between them. This study presents novel perceptions of genetic testing in participants from diverse communities across three types of genetic testing. Genetic healthcare providers should incorporate participants' perceptions, values, and beliefs into their counseling delivery as a way to engage with diverse communities.
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Cleary JL, Manalel JA, Ashida S, Marcum CS, Rewley J, Koehly L. Interpersonal Correlates of Dementia Caregivers' Emotional Support Networks: Considering Family History. Res Aging 2021; 44:405-413. [PMID: 34372731 DOI: 10.1177/01640275211026919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregiving networks of individuals with Alzheimer's disease and related dementias (ADRD) are comprised of family and friends directly involved in caregiving activities and those supporting these activities. The purpose of this study was to investigate whether caregiving-related behaviors and interactions (i.e., uplift, malfeasance, and nonfeasance), kinship tie (i.e., friend, family), and family history of ADRD were associated with caregivers' emotional support networks. Seventy-one caregivers across 30 families provided information about 776 network members. Perceived emotional support and interactions representing uplift, malfeasance, and nonfeasance were assessed. Results indicated that uplift and friendship were associated with increased, whereas nonfeasance was associated with decreased, likelihood of perceived emotional support. Caregivers with a family history of ADRD were particularly more likely to report emotional support from friends and uplifting network members. Findings suggest the need for differential strategies based on families' prior caregiving experience to facilitate positive and minimize negative interactions within caregiving networks.
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Affiliation(s)
- Jennifer L Cleary
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Jasmine A Manalel
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Jeffrey Rewley
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
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Marcum CS, Lea D, Eliezer D, Hadley DW, Koehly LM. The structure of emotional support networks in families affected by Lynch syndrome. NETWORK SCIENCE (CAMBRIDGE UNIVERSITY PRESS) 2020; 8:492-507. [PMID: 33777396 PMCID: PMC7995833 DOI: 10.1017/nws.2020.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic risk is particularly salient for families and testing for genetic conditions is necessarily a family-level process. Thus, risk for genetic disease represents a collective stressor shared by family members. According to communal coping theory, families may adapt to such risk vis-a-vis interpersonal exchange of support resources. We propose that communal coping is operationalized through the pattern of supportive relationships observed between family members. In this study, we take a social network perspective to map communal coping mechanisms to their underlying social interactions and include those who declined testing or were not at risk for Lynch Syndrome. Specifically, we examine the exchange of emotional support resources in families at risk of Lynch Syndrome, a dominantly inherited cancer susceptibility syndrome. Our results show that emotional support resources depend on the testing-status of individual family members and are not limited to the bounds of the family. Network members from within and outside the family system are an important coping resource in this patient population. This work illustrates how social network approaches can be used to test structural hypotheses related to communal coping within a broader system and identifies structural features that characterize coping processes in families affected by Lynch Syndrome.
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Affiliation(s)
- Christopher Steven Marcum
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dawn Lea
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dina Eliezer
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Donald W. Hadley
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura M. Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Marcum CS, Ashida S, Koehly LM. Primary Caregivers in a Network Context. J Gerontol B Psychol Sci Soc Sci 2020; 75:125-136. [PMID: 29304203 PMCID: PMC7179806 DOI: 10.1093/geronb/gbx165] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/17/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Caregiving to individuals affected by Alzheimer's disease and related dementia (ADRD) is a family-systems process where tasks are distributed between multiple caregivers in a network. We evaluate the extent to which multiple network members nominate one another as filling primary caregiver (PCG) roles and factors associated with nomination. METHOD Data come from the Caregiving Roles and Expectations Networks project, which aimed to characterize the caregiving networks of families affected by ADRD. All persons affected by ADRD were either full-time residents in residential care facilities or community-dwelling adult day-care participants. Generalized Poisson regression was used to model the count of incoming PCG nominations of each network member. RESULTS On average, there were multiple network members identified as PCGs across different network contexts. Network members who were perceived to perform essential caregiving tasks, such as making decisions on behalf of and spending time with the care recipient, received more primary caregiving nominations from their network peers, adjusting for personal attributes, and the context of care. DISCUSSION Having multiple PCGs in a network may result in lack of consensus in who fills those roles, potentially putting families at risk for interpersonal conflicts. Future work aimed at intervention development should fully assess the social contexts surrounding caregiving processes in order to better understand how network composition might impact outcomes.
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Affiliation(s)
- Christopher Steven Marcum
- National Institutes of Health, National Human Genome Research Institute, Social Behavioral Research Branch, Social Network Methods Section, Bethesda, Maryland
| | - Sato Ashida
- College of Public Health, Community and Behavioral Health, University of Iowa, Iowa City
| | - Laura M Koehly
- National Institutes of Health, National Human Genome Research Institute, Social Behavioral Research Branch, Social Network Methods Section, Bethesda, Maryland
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Manalel JA, Marcum CS, Calabrese S, de la Haye K, Hughes D, Prichard I, Hutchinson A, Wilson C, Koehly L. Intergenerational exchange of healthful eating encouragement: Consideration of family ancestry and disease history. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2019; 37:302-313. [PMID: 31815512 PMCID: PMC6905198 DOI: 10.1037/fsh0000448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Improving diet is a prime target for the prevention and management of chronic disease. The communal coping model suggests that families can mitigate shared risk of chronic disease through encouragement of healthful eating, eliciting preventive behaviors. METHOD Using network data from 69 Australian families across three ancestry groups (Anglo, Italian, and Asian) with varied family health histories, the present study applied social network analysis to identify patterns of intergenerational encouragement of healthful eating behavior within families, and assess whether patterns varied by family ancestry or disease density. RESULTS Findings indicated variation in patterns of health encouragement by ancestry such that Asian-Australian families were most distinct from the other ancestry groups. While there was no main effect of familial disease history, it moderated the effect of Italian ancestry on intergenerational encouragement patterns. DISCUSSION These results provide important context for future family based interventions that leverage normative patterns of intergenerational exchange of encouragement or aim to modify such patterns in an effort to improve family health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Samantha Calabrese
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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O'Neill SC, Evans C, Hamilton RJ, Peshkin BN, Isaacs C, Friedman S, Tercyak KP. Information and support needs of young women regarding breast cancer risk and genetic testing: adapting effective interventions for a novel population. Fam Cancer 2019; 17:351-360. [PMID: 29124494 DOI: 10.1007/s10689-017-0059-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Young women from hereditary breast and ovarian cancer (HBOC) families face a unique set of challenges in managing their HBOC risk, where obtaining essential information to inform decision making is key. Previous work suggests that this need for specific health information also comes at a time of heightened distress and greater individuation from family. In this report, we describe our adaptation of a previously-studied behavioral intervention for this population, utilizing a systematic approach outlined by the Centers for Disease Control and Prevention. First, we assessed the information needs and levels of distress in this population and correlates of this distress. These data then were used to inform the adaptation and piloting of a three-session telephone-based peer coaching intervention. One hundred young women (M age = 25 years) who were first or second degree relatives of BRCA1/2 mutation carriers participated. Sixty-three percent of the sample endorsed unmet HBOC information needs and they, on average, reported moderate levels of cancer-related distress (M = 21.9, SD = 14.6). Greater familial disruption was associated with greater cancer-related distress in multivariable models (p < .05). Ten women who participated in the survey completed the intervention pilot. They reported lower distress from pre- to post- (15.8 vs. 12.0), as well as significantly lower decisional conflict (p < .05) and greater endorsement of an array of healthy coping strategies (i.e., active coping, instrumental coping, positive reframing, planning, p's < .05). Our survey results suggest that young adult women from HBOC families have unmet cancer genetic information and support needs. Our pilot intervention was able to reduce levels of decisional conflict and promote the use of effective coping strategies. This approach needs to be further tested in a larger randomized trial.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Rebekah J Hamilton
- Armour Academic Center, College of Nursing, Rush University, 600 S. Paulina Street, Suite 1080, Chicago, IL, 60612, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC, 20007, USA
| | - Sue Friedman
- FORCE, Inc., 16057 Tampa Palms Blvd. W, PMB #373, Tampa, FL, 33647, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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Ersig AL, Werner-Lin A, Hoskins L, Young J, Loud JT, Peters J, Greene MH. Legacies and Relationships: Diverse Social Networks and BRCA1/2 Risk Management Decisions and Actions. JOURNAL OF FAMILY NURSING 2019; 25:28-53. [PMID: 30537877 PMCID: PMC6581043 DOI: 10.1177/1074840718815844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In families with hereditary breast/ovarian cancer, complex disease histories challenge established patterns of family communication and influence decision-making for clinical surveillance, genetic testing, and risk management. An interdisciplinary team examined longitudinal interview data from women with identified BRCA1/2 mutations to assess interactions within family and social networks about risk information communication and management. We used interpretive description to identify motivation, content, and derived benefit of these interactions. Participants discussed risk information and management strategies with biological and nonbiological network members for multiple purposes: discharging responsibility for risk information dissemination, protecting important relationships, and navigating decision trajectories. Evolving interactions with loved ones balanced long-standing family communication patterns with differing personal preferences for privacy or open sharing, whereas interactions with nonbiological network members expanded participants' range of choices for sources of risk management information. Ongoing assessment of social networks may help support engagement with risk management by aligning with patient social needs.
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Affiliation(s)
| | | | | | | | | | - June Peters
- National Institutes of Health, Bethesda, MD, USA
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