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Ballard LM, Doheny S, Dimond R, Lucassen AM, Clarke AJ. Predictive genetic testing for Huntington's disease: Exploring participant experiences of uncertainty and ambivalence between clinic appointments. J Genet Couns 2024. [PMID: 38741209 DOI: 10.1002/jgc4.1911] [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: 07/01/2023] [Revised: 04/25/2024] [Accepted: 02/05/2024] [Indexed: 05/16/2024]
Abstract
Ambivalence and uncertainty are key themes throughout the psychology of healthcare literature. This is especially so for individuals at risk of Huntington's disease (HD) deliberating the decision to undergo genetic testing because there is currently no treatment that modifies disease progression. A better understanding of the experience of making a decision about genetic prediction will help practitioners support and guide individuals through this process. Our aim was to capture participants' experiences of uncertainty and ambivalence in between their genetic counseling appointments. We explored these issues through the experiences of nine participants who were referred for predictive HD testing at four regional genetics services in England and Wales. Data consisted of recordings of clinic consultations, diaries, and an in-depth interview conducted at the end of the testing process. Data were analyzed thematically. Four themes were identified representing four possible futures, each future dependent on the decision to undergo testing and the result of that test. Our results showed that participants, as well as attending more to a future that represents their current situation of not having undergone predictive testing, also attended more to a distant future where a positive predictive result is received and symptoms have started. Participants attended less to the two futures that were more immediate once testing was undertaken (a future where a positive result is received and symptoms have not started and a future where a negative result is received). The use of diaries gave us a unique insight into these participants' experiences of ambivalence and uncertainty, psychological distress, and the emotional burden experienced. These findings help inform discussions within the clinic appointment as well as encourage researchers to consider diary use as a method of exploring what happens for individuals outside of clinical encounters.
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Affiliation(s)
- L M Ballard
- Clinical Ethics, Law & Society (CELS), Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Aldermoor Close, Southampton, UK
| | - S Doheny
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Dimond
- School of Social Science, Cardiff University, Cardiff, Wales, UK
| | - A M Lucassen
- Clinical Ethics, Law & Society (CELS), Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Aldermoor Close, Southampton, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - A J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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2
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Cooper H, Simpson J, Dale M, Eccles FJR. Experiences of young people growing up in a family with Huntington's disease: A meta-ethnography of qualitative research. J Genet Couns 2024. [PMID: 38469914 DOI: 10.1002/jgc4.1886] [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: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Huntington's disease is a genetic neurodegenerative condition with wide physical and psychological impacts. Children of a parent with the condition have a 50% chance of carrying the gene expansion and developing the condition themselves. This systematic review and meta-ethnography presents a synthesis of the qualitative research on the experiences of young people growing up in a family with Huntington's disease. The MEDLINE, PsycINFO, and CINAHL databases were systematically searched, and 13 papers met the inclusion criteria. Through the process of meta-ethnography, four themes were identified highlighting aspects of childhood that were stolen and fought for: thief of relationships, thief of self, thief of transparency, and search for reclamation. Within the themes, the complex challenges young people faced when growing up in a HD family were explored such as the impact of adverse childhood experiences and the possible effects of HD on attachment and social relationships. Clinical implications are considered, and recommendations are made for future research.
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Affiliation(s)
- Hollie Cooper
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Leicestershire, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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3
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Scott M, Watermeyer J, Wessels TM. "We are just not sure what that means or if it's relevant": Uncertainty when gathering family history information in South African prenatal genetic counseling consultations. Soc Sci Med 2024; 342:116555. [PMID: 38176214 DOI: 10.1016/j.socscimed.2023.116555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
Uncertainty impacts the process of health communication. The management and tolerance of uncertainty during healthcare discussions have gained renewed focus due to the growing challenge of obtaining and delivering complex health information, and the offer of health services in diverse contexts. Prenatal genetic counseling (GC) provides education, support and testing options for patients and couples facing a genetic or congenital diagnosis or risk during pregnancy. Gathering detailed and accurate family history information is essential to determine a patient's genetic risk. In South Africa, contextual factors such as patient literacy, language diversity, limited written patient health records, and a lack of familiarity with GC services may increase the potential for misunderstandings during GC consultations. This study uses a qualitative sociolinguistic approach to analyse 9 video-recorded South African prenatal GC consultations to understand the impact of uncertainty on the process of gathering family history information. The findings reveal uncertainty is introduced in different ways during family history taking. This includes when patients have no knowledge about their family history; when they have some knowledge but the details are unclear; or when patients have knowledge but the details are confusing. Uncertainty can lead to interactional trouble in the form of knowledge asymmetries, interrogative questioning, reversals in epistemic authority, and the potential for mistrust. Suggestions are made for how genetic specialists can manage uncertainty in GC family history taking. These include recognizing contextual sources of uncertainty, understanding how patients may respond to uncertainty and being aware of personal responses to moments of discomfort. Specific communication training recommendations and video-based sociolinguistic methods to enhance reflection and communication practice are highlighted. These approaches may enhance the effectiveness of GC communication and strengthen patient-specialist relationships, especially in diverse settings.
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Affiliation(s)
- Megan Scott
- The Health Communication Research Unit (HCRU), School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jennifer Watermeyer
- The Health Communication Research Unit (HCRU), School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Tina-Marie Wessels
- Division of Human Genetics, Department of Pathology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
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4
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Kjoelaas S, Feragen KB, Jensen TK. Social support experiences when growing up with a parent with Huntington’s disease. Health Psychol Behav Med 2022; 10:655-675. [PMID: 35923579 PMCID: PMC9341327 DOI: 10.1080/21642850.2022.2104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Social support is a strong protector factor against the many negative effects stress and adversity in childhood can have on short- and long-term health. However, for young people who are exposed to adversity because their parent suffers from severe neurodegenerative disease, such as Huntington’s disease (HD), support from close caregiving relationships can be compromised. This study aimed to investigate what current and past experiences young people who grow up with a parent with HD have with social support outside the parent–child context. Methods A total of 36 semi-structured qualitative interviews with individuals who had current and past experiences growing up with a parent with HD were analysed using thematic analysis. Findings Relationships were experienced as supportive when they provided a sense of love, care, or belonging; when they provided coping skills; and when they reduced or alleviated stressors at home. Barriers to receiving and accepting support included their parent’s and others’ lack of acknowledgement and understanding about their situation and the young people’s own need to protect themselves or their family from support they feared could cause harm. Conclusion Our findings highlight the many important roles persons other than caregivers can have in helping young people who grow up with the distress and adversity of having a parent with a severe disease, such as HD. The findings suggest that by sustaining positive and adaptive emotions and/ or changing distressing emotions, social support help and can compensate for a lack of support in their caregiving relationships. In order for others to be experienced as supportive, the many barriers this vulnerable group may encounter must be addressed and overcome. Most importantly, support providers must understand how HD affects young people.
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Affiliation(s)
- Siri Kjoelaas
- Centre for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Tine K. Jensen
- Department of Psychology, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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5
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Godino L, Turchetti D, Jackson L, Hennessy C, Skirton H. Genetic counselling as a route to enhanced autonomy: using a sequential mixed methods research approach to develop a theory regarding presymptomatic genetic testing for young adults at risk of inherited cancer syndromes. J Community Genet 2021; 12:685-691. [PMID: 34415557 DOI: 10.1007/s12687-021-00548-x] [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: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022] Open
Abstract
Undertaking presymptomatic or predictive genetic testing should involve a considered choice. Decisions regarding genetic testing for young adults have to be considered within the context of their key life stage, which may involve developing a career, forming partnerships and/or becoming parents. The aim of this study was to develop a theoretical model regarding the factors involved when young adults (18-30 years) undergo presymptomatic genetic testing for inherited cancer syndromes. The model evolved from synthesis of results of a sequential mixed methods study involving a systematic review, a qualitative study and a quantitative study. The resulting model shows that young adults at risk of inherited cancer syndromes are influenced by others to have testing and come to counselling with their decision already made. However, genetic counselling enhances their feelings of autonomy and integration of their genetic status into their lives. Our theoretical model could be a valid support during the genetic counselling process for young adults and their parents, as it may sensitise professionals to the specific needs of this population, including education and support to autonomous decision-making. Counselling approaches should be modified in this population: an inclusive, multi-step counselling process is needed, with timing and setting set according to the specific features of this sensitive population.
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Affiliation(s)
- Lea Godino
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. .,School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK. .,Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer, University of Bologna, Bologna, Italy.
| | - Daniela Turchetti
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | | | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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6
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Mahmood S, Law S, Bombard Y. "I have to start learning how to live with becoming sick": A scoping review of the lived experiences of people with Huntington's disease. Clin Genet 2021; 101:3-19. [PMID: 34216010 DOI: 10.1111/cge.14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023]
Abstract
Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide. The experience of illness through a person's perspective is one domain defining PCC contributing to a growing interest in examining the lived experiences of illness. This scoping review sought to examine what is known from the existing literature about the lived experiences of persons gene-positive for or living with Huntington's disease (HD) as described in their own voices and to outline prominent psychosocial themes of those experiences. Five databases were systematically searched and analyzed resulting in 19 publications for inclusion. Using a thematic analysis, five prominent psychosocial themes were identified: grappling with control, avoidance as an escape from realities, adaptation to new realities, managing emotions, and appreciation for life. Variation in themes existed across HD life stage of being undiagnosed or diagnosed with HD. The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.
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Affiliation(s)
- Saadia Mahmood
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Service Research Group, St. Michael's Hospital - Unity Health Toronto, Toronto, Ontario, Canada
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7
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Forbes Shepherd R, Werner-Lin A, Keogh LA, Delatycki MB, Forrest LE. “I need to know if I’m going to die young”: Adolescent and young adult experiences of genetic testing for Li–Fraumeni syndrome. J Psychosoc Oncol 2020; 39:54-73. [DOI: 10.1080/07347332.2020.1768199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Allison Werner-Lin
- School of Social Policy and Practice, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louise A. Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Clinical Genetics Service, Parkville, Victoria, Australia
| | - Laura E. Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Spiers J, Smith JA, Ferrer-Duch M, Moldovan R, Roche J, MacLeod R. Evaluating a genetic counseling narrative group session for people who have tested positive for the Huntington's disease expansion: An interpretative phenomenological analysis. J Genet Couns 2020; 29:1015-1025. [PMID: 32077165 DOI: 10.1002/jgc4.1229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/20/2019] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disorder characterized by motor problems, cognitive impairment, and mood disturbances. Given the emotional elements of both HD itself and the testing process for it, psychological interventions may be helpful for those families impacted by HD. A stand-alone genetic counseling narrative group has been offered by one regional genetics clinic in the north of England to support people's coping following predictive genetic testing for HD. Groups are held 4-5 times per year with patients attending a group on a single occasion. This study assessed participants' experiences of attending a group using the qualitative method interpretative phenomenological analysis (IPA). Telephone interviews were conducted with 12 people who had a mutation-positive HD predictive test result and who had taken part in a genetic counseling narrative group session between November 2017 and February 2018. Participants were asked about their experiences of the group and any impact it had had on their lives. Four themes emerged: 'The power of the group, 'Active elements of the narrative exercise', 'Subsequent impact of the session', and 'Another voice'. Participants described the positive impact of being able to meet and empathize with others in a similar situation, the group's positive impact on their mood and future outlook, and its beneficial impact on disclosure. While most participants were positive about the session, the final theme presented the voices of two participants for whom the groups were poorly timed. Given the sessions' generally positive impact, we recommend other centers consider offering people impacted by HD similar sessions.
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Affiliation(s)
| | | | | | - Ramona Moldovan
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Jay Roche
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rhona MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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9
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Lewit-Mendes MF, Lowe GC, Lewis S, Corben LA, Delatycki MB. Young People Living at Risk of Huntington's Disease: The Lived Experience. J Huntingtons Dis 2019; 7:391-402. [PMID: 30372686 DOI: 10.3233/jhd-180308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For young people in families with Huntington's disease (HD) the challenge of having an affected family member (AFM) compounds challenges related to being at risk of HD themselves. OBJECTIVE This study aimed to quantitatively examine the experiences of young people in families with HD, adding to existing qualitative studies regarding teenagers and young adults in families with HD. METHODS The experiences of young people with living in a family with HD were captured by an online anonymous questionnaire, available worldwide through the Huntington's Disease Youth Organization. The questionnaire contained mostly forced choice questions. RESULTS Most participants (n = 84/101, 83.2%) provide assistance to an AFM and 46.4% (n = 39/84) wish they didn't have to look after their AFM. Many participants (n = 64/78, 82.1%) reported feeling anxious about being at risk; 64.9% (n = 50/77) agreed it is a barrier in their life. Over one third (n = 29/76, 38.2%) of participants disagreed that they have support in relation to being at risk, despite 85.5% (n = 65/76) agreeing it is important to have support and ongoing follow up. CONCLUSIONS Young people in families with HD endure considerable emotional, social and practical burden secondary to having an AFM and being at risk themselves. Without increased support and services, the effects of being a young caregiver and living at risk are likely to have long term impacts on the well-being of these young people.
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Affiliation(s)
- Miranda F Lewit-Mendes
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Georgia C Lowe
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Louise A Corben
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, VIC, Australia
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10
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Keenan KF, McKee L, Miedzybrodzka Z. Genetics professionals’ experiences of facilitating parent/child communication through the genetic clinic. J Genet Couns 2019; 29:44-55. [DOI: 10.1002/jgc4.1179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Karen F. Keenan
- Medical Genetics Group University of Aberdeen Aberdeen UK
- Epidemiology Group University of Aberdeen Aberdeen UK
| | - Lorna McKee
- Health Services Research Unit University of Aberdeen Aberdeen UK
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11
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Clarke AJ, Wallgren-Pettersson C. Ethics in genetic counselling. J Community Genet 2019; 10:3-33. [PMID: 29949066 PMCID: PMC6325035 DOI: 10.1007/s12687-018-0371-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient's family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient's community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.
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Affiliation(s)
- Angus J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XN, UK.
| | - Carina Wallgren-Pettersson
- The Folkhaelsan Department of Medical Genetics, Topeliusgatan, 20 00250, Helsinki, Finland
- The Folkhaelsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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12
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Dondanville DS, Hanson-Kahn AK, Kavanaugh MS, Siskind CE, Fanos JH. "This could be me": exploring the impact of genetic risk for Huntington's disease young caregivers. J Community Genet 2018; 10:291-302. [PMID: 30430455 DOI: 10.1007/s12687-018-0395-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
Abstract
Huntington's disease (HD) is a predominantly adult-onset, genetic, neurodegenerative condition. Children of affected individuals have a 50% risk of inheriting HD and often assume caregiving roles for their parent. Studies specifically focused on HD young caregivers have proposed that the genetic risk component of HD "exacerbates" the caregiving experience and identified common responsibilities, burdens, and support needs, but none have explored the relationship between the caregiving role and perception of genetic risk. In an attempt to understand this relationship, we conducted a qualitative study to explore the interaction between a young caregiver's perception of genetic risk, the caregiving experience, and thoughts about and plans for predictive testing. Thirteen individuals between 15 and 25 years who provided care for a parent with HD were recruited from two HD youth groups and local support groups. Interviews were recorded, transcribed, and analyzed thematically. Two themes emerged: (1) caregiving and thoughts about risk and (2) caregiving and perceived opinions towards genetic testing. Our findings suggest that the genetic risk colors the caregiving experience by evoking feelings about the future and a potential diagnosis of HD, in addition to impacting plans for predictive testing. Genetic counselors can use these findings to inform their understanding of caregiver experiences, which can aid them when helping patients explore their motivations for testing during a genetic counseling session. Future studies should explore the extent to which health care providers acknowledge the work of young caregivers in the home and provide support to these individuals.
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Affiliation(s)
- Danielle S Dondanville
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Andrea K Hanson-Kahn
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pediatrics, Division of Medical Genetics, Stanford University Medical Center, Stanford, CA, USA
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carly E Siskind
- Department of Neurology, Stanford Health Care, Palo Alto, CA, USA
| | - Joanna H Fanos
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
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13
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A Systematic Review of How Young People Live with Inherited Disease: What Can We Learn for Li-Fraumeni Syndrome? J Adolesc Young Adult Oncol 2018; 7:525-545. [DOI: 10.1089/jayao.2018.0028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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14
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Keenan KF, Finnie RM, Simpson WG, McKee L, Dean J, Miedzybrodzka Z. Parents' views of genetic testing and treatment of familial hypercholesterolemia in children: a qualitative study. J Community Genet 2018; 10:129-141. [PMID: 29949065 PMCID: PMC6325044 DOI: 10.1007/s12687-018-0373-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/01/2018] [Indexed: 01/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a serious inherited disorder, which greatly increases individuals’ risk of cardiovascular disease (CVD) in adult life. However, medical treatment and lifestyle adjustments can fully restore life expectancy. Whilst European guidance advises that where there is a known family mutation genetic testing is undertaken in early childhood, the majority of the at-risk population remain untested and undiagnosed. To date, only a small number of studies have explored parents’ and children’s experiences of testing and treatment for FH, and little is known about interactions between health professionals, parents, and children in clinic settings. In this study, in-depth interviews were undertaken with parents who had attended a genetics and/or lipid clinic for FH with their children (n = 17). A thematic analysis revealed four main themes: undertaking early prevention, postponing treatment, parental concerns, and the importance of the wider family context. The majority of parents supported genetic testing for FH in childhood. However, although some were very supportive of following early treatment recommendations, others expressed reluctance. Importantly, some parents were concerned that inappropriate information had been shared with their children and wished that more time had been given to discuss how, when, and what to tell in advance. Future research is needed to explore the long-term outcomes for children who undertake genetic testing and early treatment for FH and to trial interventions to improve the engagement, follow-up, and support of children who are at risk, or diagnosed, with this disorder.
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Affiliation(s)
- Karen Forrest Keenan
- Epidemiology Group, University of Aberdeen, First Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. .,Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.
| | - Robert M Finnie
- Department of Medicine/Care of the Elderly, St. Johns Hospital, Howdon Road West, Livingston, UK.,Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William G Simpson
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Third Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - John Dean
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
| | - Zosia Miedzybrodzka
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
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What to Do with a Second Chance in Life? Long-Term Experiences of Non-carriers of Huntington’s Disease. J Genet Couns 2018; 27:1438-1446. [DOI: 10.1007/s10897-018-0257-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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Ibisler A, Ocklenburg S, Stemmler S, Arning L, Epplen JT, Saft C, Hoffjan S. Prospective Evaluation of Predictive DNA Testing for Huntington's Disease in a Large German Center. J Genet Couns 2017; 26:1029-1040. [PMID: 28361381 DOI: 10.1007/s10897-017-0085-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
Abstract
We present a prospective study of counselees seeking predictive testing for Huntington's disease at the Huntington Center North Rhine-Westphalia (Bochum, Germany) between 2010 and 2012. The aim was to observe the decision-making process of at-risk individuals and explore their experiences following the decision as well as the impacts of positive and negative mutation results. Data were collected using two standardized questionnaires as well as via a semi-standardized telephone interview one year after the initial counseling session. Seventy-two individuals participated in at least one of the three phases of the survey, including 31 individuals in the telephone interview. Sociodemographic data were in accordance with previous reports. The process of predictive testing was generally perceived in a positive manner, with almost all interviewees reporting a balanced emotional state one year after initial counseling, regardless of the decision for or against the test. The most important reasons named in favor of or against testing were assembled as well as different aspects regarding the satisfaction with the reached decision. In line with and expanding previous observations on gender-related differences in decision-making, our results suggest that gender-related aspects should be more strongly taken into account in genetic counseling during the predictive testing and counseling processes.
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Affiliation(s)
- Aysegül Ibisler
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany. .,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.
| | - Sebastian Ocklenburg
- Department of Biopsychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Susanne Stemmler
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Larissa Arning
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Jörg T Epplen
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.,Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Carsten Saft
- Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.,Department of Neurology, St. Josef Hospital, Huntington Center NRW, Ruhr-University Bochum, Bochum, Germany
| | - Sabine Hoffjan
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
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Nance MA. Genetic counseling and testing for Huntington's disease: A historical review. Am J Med Genet B Neuropsychiatr Genet 2017; 174:75-92. [PMID: 27174011 DOI: 10.1002/ajmg.b.32453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 12/26/2022]
Abstract
This manuscript describes the ways in which genetic counseling has evolved since John Pearson and Sheldon Reed first promoted "a genetic education" in the 1950s as a voluntary, non-directive clinical tool for permitting individual decision making. It reviews how the emergence of Huntington's disease (HD) registries and patient support organizations, genetic testing, and the discovery of a disease-causing CAG repeat expansion changed the contours of genetic counseling for families with HD. It also reviews the guidelines, outcomes, ethical and laboratory challenges, and uptake of predictive, prenatal, and preimplantation testing, and it casts a vision for how clinicians can better make use of genetic counseling to reach a broader pool of families that may be affected by HD and to ensure that genetic counseling is associated with the best levels of care. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Martha A Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota.,Hennepin County Medical Center, Minneapolis, Minnesota
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