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Massie J. Overcoming the burden of cystic fibrosis. Med J Aust 2023; 218:118-119. [PMID: 36641140 DOI: 10.5694/mja2.51837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Affiliation(s)
- John Massie
- Royal Children's Hospital Melbourne, Melbourne, VIC
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2
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van den Heuvel LM, van den Berg N, Janssens ACJW, Birnie E, Henneman L, Dondorp WJ, Plantinga M, van Langen IM. Societal implications of expanded universal carrier screening: a scoping review. Eur J Hum Genet 2023; 31:55-72. [PMID: 36097155 PMCID: PMC9822904 DOI: 10.1038/s41431-022-01178-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023] Open
Abstract
Carrier screening aims to identify couples at risk of conceiving children with a recessive condition. Until recently, carrier screening was primarily offered ancestry-based. Technological advances now facilitate expanded universal carrier screening (EUCS). This scoping review aimed to map EUCS's potential societal implications based on both theoretical studies and empirical evidence. To this aim, we performed a CoCites search to find relevant articles, including articles describing carrier screening for at-risk populations, based on five selected query articles. Forty articles were included. Three main potential societal implications were identified: (1) unwanted medicalization, (2) stigmatization and discrimination of carriers and people affected with the conditions screened and (3) challenges in achieving equitable access. Within these themes, potential positive implications are reduction of ethnic stigmatization in ancestry-based offers and increased equity. Potential negative implications are reinforcement of disability-based stigmatization, less possibility for developing expertise in healthcare and societal pressure to partake in screening. Empirical evidence on all these implications is however scarce. In conclusion, both positive and negative potential societal implications of implementing EUCS, primarily theoretical, were identified, even in at-risk groups where evidence is mostly lacking. Empirical research in EUCS pilots is needed to identify which societal implications are likely to occur and therefore should be overcome when implementing EUCS.
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Affiliation(s)
- Lieke M. van den Heuvel
- grid.4494.d0000 0000 9558 4598Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Human Genetics and Amsterdam Reproduction and Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nina van den Berg
- grid.4494.d0000 0000 9558 4598Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Human Genetics and Amsterdam Reproduction and Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A. Cecile J. W. Janssens
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Erwin Birnie
- grid.4494.d0000 0000 9558 4598Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lidewij Henneman
- grid.12380.380000 0004 1754 9227Department of Human Genetics and Amsterdam Reproduction and Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wybo J. Dondorp
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - Mirjam Plantinga
- grid.4494.d0000 0000 9558 4598Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M. van Langen
- grid.4494.d0000 0000 9558 4598Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Hussein N, Henneman L, Kai J, Qureshi N. Preconception risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease. Cochrane Database Syst Rev 2021; 10:CD010849. [PMID: 34634131 PMCID: PMC8504980 DOI: 10.1002/14651858.cd010849.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Globally, about 6% of children are born with a serious birth defect of genetic or partially genetic origin. Carrier screening or testing is one way to identify couples at increased risk of having a child with an autosomal recessive condition. The most common autosomal recessive conditions are thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease, with higher carrier rates in high-risk populations of specific ancestral backgrounds. Identifying and counselling couples at genetic risk of the conditions before pregnancy enables them to make fully informed reproductive decisions, with some of these choices not being available if testing is only offered in an antenatal setting. This is an update of a previously published review. OBJECTIVES To assess the effectiveness of systematic preconception genetic risk assessment to enable autonomous reproductive choice and to improve reproductive outcomes in women and their partners who are both identified as carriers of thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease in healthcare settings when compared to usual care. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Registers. Date of latest search of the registers: 04 August 2021. In addition, we searched for all relevant trials from 1970 (or the date at which the database was first available if after 1970) to date using electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), clinical trial databases (National Institutes of Health, Clinical Trials Search portal of the World Health Organization, metaRegister of controlled clinical trials), and hand searching of key journals and conference abstract books from 1998 to date (European Journal of Human Genetics, Genetics in Medicine, Journal of Community Genetics). We also searched the reference lists of relevant articles, reviews and guidelines and also contacted subject experts in the field to request any unpublished or other published trials. Date of latest search of all these sources: 25 June 2021. SELECTION CRITERIA: Any randomised controlled trials (RCTs) or quasi-RCTs (published or unpublished) comparing reproductive outcomes of systematic preconception genetic risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease when compared to usual care. DATA COLLECTION AND ANALYSIS We identified 37 papers, describing 22 unique trials which were potentially eligible for inclusion in the review. However, after assessment, we found no RCTs of preconception genetic risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease. MAIN RESULTS No RCTs of preconception genetic risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease are included. A trial identified earlier has published its results and has subsequently been listed as excluded in this review. AUTHORS' CONCLUSIONS As there are no RCTs of preconception genetic risk assessment for thalassaemia, sickle cell disease, cystic fibrosis, or Tay-Sachs disease included in either the earlier or current versions of this review, we recommend considering potential non-RCTs studies (for example prospective cohorts or before-and-after studies) for future reviews. While RCTs are desirable to inform evidence-based practice and robust recommendations, the ethical, legal and social implications associated with using this trial design to evaluate the implementation of preconception genetic risk assessment involving carrier testing and reproductive autonomy must also be considered. In addition, rather than focusing on single gene-by-gene carrier testing for specific autosomal-recessive conditions as the intervention being evaluated, preconception expanded genetic screening should also be included in future searches as this has received much attention in recent years as a more pragmatic strategy. The research evidence for current international policy recommendations is limited to non-randomised studies.
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Affiliation(s)
- Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lidewij Henneman
- Director Amsterdam Reproduction & Development research institute (AR&D), Amsterdam University Medical Centers, Amsterdam, Netherlands
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Perreira TA, Perrier L, Prokopy M, Neves-Mera L, Persaud DD. Physician engagement: a concept analysis. J Healthc Leadersh 2019; 11:101-113. [PMID: 31440112 PMCID: PMC6666374 DOI: 10.2147/jhl.s214765] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.
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Affiliation(s)
- Tyrone A Perreira
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Prokopy
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Lina Neves-Mera
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - D David Persaud
- School of Health Administration at Dalhousie University, Dalhousie University, Halifax, Nova Scotia, Canada
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Mosconi P, Colombo C, Roberto A, Candiani G, Greco MT, Satolli R, Castellani C. Deciding on cystic fibrosis carrier screening: three citizens' juries and an online survey. Eur J Public Health 2019; 28:973-977. [PMID: 29562330 PMCID: PMC6148966 DOI: 10.1093/eurpub/cky032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Health technology assessment and ethical issues have to be dealt with in deciding on national carrier screening for cystic fibrosis (CF)—the most frequent severe autosomal recessive disease in Caucasian populations and several stakeholders need to be involved. A citizens’ jury is one way to ask citizens to deliberate on controversial topics in the interests of a society. The aims of this project were to gather opinions about CF carrier screening through citizens' jury deliberations and to match them with the findings of a large online consultation survey open to the general population, people with CF and families and health professionals. Methods Three citizens’ juries and an online survey were asked: ‘Should the Health Service organize screening of the population with the aim of identifying healthy people who may have children with CF?’ The jurors had no medical background and no personal or family CF history. The survey was open to people with CF, families, and healthcare professionals. Results Jurors and survey respondents were in favour of CF carrier screening, mainly considering the severity of CF, the value of informed reproductive choices and the equality of the screening. All the citizens’ juries felt positively about the health service actively offer CF carrier screening to provide women and couples of reproductive age equal access and standardized information on the pros and cons. Conclusion Considering the favourable attitude towards CF screening, the feasibility of CF screening, in terms of best setting, target age and healthcare professionals providing it, should be tested in a clinical trial.
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Affiliation(s)
- Paola Mosconi
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Cinzia Colombo
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Anna Roberto
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Maria Teresa Greco
- Laboratory of Methodology for Clinical Research, Department of Oncology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Carlo Castellani
- Centro Fibrosi Cistica dell'Azienda Ospedaliera Interuniversitaria Integrata, Verona, Italy.,Centro Fibrosi Cistica, Ospedale Gaslini, Genoa, Italy
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Chardon JW, Jasmin BJ, Kothary R, Parks RJ. Report on the 4th Ottawa International Conference on Neuromuscular Disease and Biology - September 5-7, 2017, Ottawa, Canada. J Neuromuscul Dis 2018; 5:539-552. [PMID: 30373960 DOI: 10.3233/jnd-180353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jodi Warman Chardon
- Department of Medicine, The Ottawa Hospital and University of Ottawa, ON, Canada.,Department of Pediatrics (Genetics), Children's Hospital of Eastern Ontario, ON, Canada.,Neuroscience Program, Ottawa Hospital Research Institute, ON, Canada.,Centre for Neuromuscular Disease, University of Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
| | - Bernard J Jasmin
- Centre for Neuromuscular Disease, University of Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
| | - Rashmi Kothary
- Department of Medicine, The Ottawa Hospital and University of Ottawa, ON, Canada.,Centre for Neuromuscular Disease, University of Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, ON, Canada
| | - Robin J Parks
- Department of Medicine, The Ottawa Hospital and University of Ottawa, ON, Canada.,Centre for Neuromuscular Disease, University of Ottawa, ON, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, ON, Canada
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Holtkamp KCA, Henneman L, Gille JJP, Meijers-Heijboer H, Cornel MC, Lakeman P. Direct-to-consumer carrier screening for cystic fibrosis via a hospital website: a 6-year evaluation. J Community Genet 2018; 10:249-257. [PMID: 30229537 PMCID: PMC6435772 DOI: 10.1007/s12687-018-0388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
Abstract
A Dutch university hospital started offering cystic fibrosis (CF) carrier screening directly to consumers (DTC) through their website in 2010. A 6-year process evaluation was conducted to evaluate the offer. Screening was implemented as intended. However, uptake was lower than expected. Forty-four tests have been requested, partly by couples with a positive family history for CF, which was not the intended target group. Users were generally positive about the screening offer, citing accessibility, ease of testing, anonymity, and perceived shortcomings of regular healthcare as reasons for requesting screening. DTC CF carrier screening via a university hospital website is feasible, but is seldom used. Considering technological advances, continuation of this specific offer is questionable.
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Affiliation(s)
- Kim C A Holtkamp
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Johan J P Gille
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
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Stakeholder perspectives on the implementation of genetic carrier screening in a changing landscape. BMC Health Serv Res 2017; 17:146. [PMID: 28209157 PMCID: PMC5314610 DOI: 10.1186/s12913-017-2083-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 01/24/2023] Open
Abstract
Background In most countries, genetic carrier screening is neither offered, nor embedded in mainstream healthcare. Technological developments have triggered a two-fold transition in carrier screening: the expansion from screening one single disorder to many disorders simultaneously, and offering screening universally, regardless of ancestry. This study aims to identify general and population-specific barriers and needs reflected by stakeholders regarding the implementation of carrier screening in a changing landscape. Methods Seventeen semi-structured interviews were conducted with Dutch key stakeholders working in the practical and scientific field of carrier screening. The constellation approach was used to categorise barriers and needs into three levels: culture, structure and practice. Results Barriers on a cultural level include: undecidedness about the desirability of carrier screening, and a lack of priority of screening in mainstream healthcare. On a structural level barriers included: need for organisational structures in healthcare for embedding carrier screening, need for guidelines, financial structures, practical tools for overcoming challenges during counselling, and a need for training and education of both professionals and the public. A lack of demand for screening by the public, and a need for a division of responsibilities were barriers on a practical level. Conclusion The absence of a collective sense of urgency for genetic carrier screening, a lack of organisational structures, and uncertainty or even disagreement about the responsibilities seem to be important barriers in the implementation of carrier screening. Stakeholders therefore suggest that change agents should be formally acknowledged to strategically plan broadening of current initiatives and attune different stakeholders. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2083-9) contains supplementary material, which is available to authorized users.
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Dickinson JE. Preconception assessment: an opportunity often lost. Aust N Z J Obstet Gynaecol 2014; 54:501-2. [PMID: 25476807 DOI: 10.1111/ajo.12295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jan E Dickinson
- Australian and New Zealand Journal of Obstetrics and Gynaecology, School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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