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Higgs E, Wain KE, Wynn J, Cho MT, Higgins S, Blaisdell D, Dugan D, Valek S, Cohen S. Measuring quality and value in genetic counseling: The current landscape and future directions. J Genet Couns 2022; 32:315-324. [PMID: 36385723 DOI: 10.1002/jgc4.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
Genetic counselors strive to provide high-quality genetic services. To do so, it is essential to define quality in genetic counseling and identify opportunities for improvement. This Professional Issues article provides an overview of the evaluation of healthcare quality in genetic counseling. The National Society of Genetic Counselors' Research, Quality, and Outcomes Committee partnered with Discern Health, a value-based healthcare policy consulting firm, to develop a care continuum model of genetic counseling. Using the proposed model, currently available quality measures relevant to genetic counseling in the US healthcare system were assessed, allowing for the identification of gaps and priority areas for further development. A total of 560 quality measures were identified that can be applied to various aspects of the care continuum model across a range of clinical specialty areas in genetic counseling, although few measures were specific to genetic counseling or genetic conditions. Areas where quality measures were lacking included: attitudes toward genetic testing, family communication, stigma, and issues of justice, equity, diversity, and inclusion. We discuss these findings and other strategies for an evidence-based approach to quality in genetic counseling. Strategic directions for the genetic counseling profession should include a consolidated approach to research on quality and value of genetic counseling, development of quality metrics and patient-experience measures, and engagement with other improvement activities. These strategies will allow for benchmarking, performance improvement, and future implementation in accountability programs which will strengthen genetic counseling as a profession that provides evidence-based high-quality care to all patients.
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Affiliation(s)
- Emily Higgs
- Cardiovascular Genetics Program, University of California San Francisco California USA
| | | | - Julia Wynn
- Department of Pediatrics Columbia University Irving Medical Center New York New York USA
| | - Megan T. Cho
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health Bethesda Maryland USA
| | | | - David Blaisdell
- Discern Health, Part of Real Chemistry San Francisco California USA
| | - Donna Dugan
- Discern Health, Part of Real Chemistry San Francisco California USA
| | - Sara Valek
- Discern Health, Part of Real Chemistry San Francisco California USA
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Systematic review of outcomes in studies of reproductive genetic carrier screening: Towards development of a core outcome set. Genet Med 2021; 24:1-14. [PMID: 34906455 DOI: 10.1016/j.gim.2021.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/09/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Current practice recommendations support the widespread implementation of reproductive genetic carrier screening (RGCS). These consensus-based recommendations highlight a research gap, with findings from current studies being insufficient to meet the standard required for more rigorous evidence-based recommendations. This systematic review assessed methodological aspects of studies on RGCS to inform the need for a core outcome set. METHODS We conducted a systematic search to identify peer-reviewed published studies offering population-based RGCS. Study designs, outcomes, and measurement methods were extracted. A narrative synthesis was conducting using an existing outcome taxonomy and criteria used in the evaluation of genetic screening programs as frameworks. RESULTS Sixty-five publications were included. We extracted 120 outcomes representing 24 outcome domains. Heterogeneity in outcome selection, measurement methods and time points of assessment was extensive. Quality appraisal raised concerns for bias. We found that reported outcomes had limited applicability to criteria used to evaluate genetic screening programs. CONCLUSION Despite a large body of literature, diverse approaches to research have limited the conclusions that can be cumulatively drawn from this body of evidence. Consensus regarding meaningful outcomes for evaluation of RGCS would be a valuable first step in working towards evidence-based practice recommendations, supporting the development of a core outcome set.
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The Clinician-reported Genetic testing Utility InDEx (C-GUIDE): Preliminary evidence of validity and reliability. Genet Med 2021; 24:430-438. [PMID: 34906486 DOI: 10.1016/j.gim.2021.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Demonstrating the clinical utility of genetic testing is fundamental to clinical adoption and reimbursement, but standardized definitions and measurement strategies for this construct do not exist. The Clinician-reported Genetic testing Utility InDEx (C-GUIDE) offers a novel measure to fill this gap. This study assessed its validity and inter-rater reliability. METHODS Genetics professionals completed C-GUIDE after disclosure of test results to patients. Construct validity was assessed using regression analysis to measure associations between C-GUIDE and global item scores as well as potentially explanatory variables. Inter-rater reliability was assessed by administering a vignette-based survey to genetics professionals and calculating Krippendorff's α. RESULTS On average, a 1-point increase in the global item score was associated with an increase of 3.0 in the C-GUIDE score (P < .001). Compared with diagnostic results, partially/potentially diagnostic and nondiagnostic results were associated with a reduction in C-GUIDE score of 9.5 (P < .001) and 10.2 (P < .001), respectively. Across 19 vignettes, Krippendorff's α was 0.68 (95% CI: 0.63-0.72). CONCLUSION C-GUIDE showed acceptable validity and inter-rater reliability. Although further evaluation is required, C-GUIDE version 1.2 can be useful as a standardized approach to assess the clinical utility of genetic testing.
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Richardson E, McEwen A, Newton-John T, Manera K, Jacobs C. The Core Outcome DEvelopment for Carrier Screening (CODECS) study: protocol for development of a core outcome set. Trials 2021; 22:480. [PMID: 34294124 PMCID: PMC8296650 DOI: 10.1186/s13063-021-05439-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Reproductive genetic carrier screening is a type of genetic testing available to those planning a pregnancy, or during their first trimester, to understand their risk of having a child with a severe genetic condition. There is a lack of consensus for ‘what to measure’ in studies on this intervention, leading to heterogeneity in choice of outcomes and methods of measurement. Such outcome heterogeneity has implications for the quality and comparability of these studies and has led to a lack of robust research evidence in the literature to inform policy and decision-making around the offer of this screening. As reproductive genetic carrier screening becomes increasingly accessible within the general population, it is timely to investigate the outcomes of this intervention. Objectives The development of a core outcome set is an established methodology to address issues with outcome heterogeneity in research. We aim to develop a core outcome set for reproductive genetic carrier screening to clarify and standardise outcomes for research and practice. Methods In accordance with guidance from the COMET (Core Outcome Measures in Effectiveness Trials) Initiative, this study will consist of five steps: (i) a systematic review of quantitative studies, using narrative synthesis to identify previously reported outcomes, their definitions, and methods of measurement; (ii) a systematic review of qualitative studies using content analysis to identify excerpts related to patient experience and perspectives that can be interpreted as outcomes; (iii) semi-structured focus groups and interviews with patients who have undertaken reproductive genetic carrier screening to identify outcomes of importance to them; (iv) Delphi survey of key stakeholders, including patients, clinicians, and researchers, to refine and prioritise the list of outcomes generated from the previous steps; and (v) a virtual consensus meeting with a purposive sample of key stakeholders to finalise the core outcome set for reporting. Discussion This protocol outlines the core outcome set development process and its novel application in the setting of genetic testing. This core outcome set will support the standardisation of outcome reporting in reproductive carrier screening research and contribute to an evolving literature on outcomes to evaluate genetic testing and genetic counselling as health interventions. COMET core outcome set registration http://www.comet-initiative.org/Studies/Details/1381.
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Affiliation(s)
- Ebony Richardson
- Graduate School of Health, University of Technology Sydney, Building 20, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia.
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Building 20, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Building 20, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, NSW, 2006, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Building 20, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia
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Redlinger-Grosse K, MacFarlane IM, Cragun D, Zierhut H. A Delphi study to prioritize genetic counseling outcomes: What matters most. J Genet Couns 2020; 30:676-692. [PMID: 33179357 DOI: 10.1002/jgc4.1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
Research on genetic counseling outcomes has examined a range of metrics many that differ in quality and extent of psychometric assessment and in some cases fail to encompass potential benefits of genetic counseling for patients. Although a variety of possible outcomes have been explored, selecting the most important or relevant outcomes and identifying well-validated measures remain challenging. An online, modified Delphi method was used to prioritize genetic counseling outcomes from the viewpoint of individuals from four stakeholder groups - clinical genetic counselors, outcome researchers, genetic counseling training directors, and genetic counseling consumers/advocates. A survey of 181 genetic counseling outcomes were rated based on perceived importance and then sorted and categorized using the Framework for Outcomes of Clinical Communication Services in Genetic Counseling (FOCUS-GC) framework. Three of the FOCUS-GC domains (Process, Patient Care Experience, and Patient Changes) were assessed as most important, while none of the most highly rated outcomes fell into the domains of Patient Health or Family Changes. The majority of outcomes deemed most important by stakeholder groups were within the process domain. When looking at the proportion of outcomes that overlapped with the consumer group, clinical genetic counselors had the highest degree of similarity with consumers when looking at the high relative importance band outcomes (61.1% overlap), followed by training directors (58.3%), and outcome researchers (41.7%). Variability in importance according to stakeholder groups was an important consideration and prioritizing outcomes was challenging given that the majority of outcomes were rated as important. Working to bridge the realities of clinical care and fundamental differences in the viewpoints and priorities of genetic counseling research directions is an area for future exploration.
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Affiliation(s)
| | | | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
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Juarez OA, Pencheva BB, Bellcross C, Schneider KW, Turner J, Porter CC. Cancer genetic counseling for childhood cancer predisposition is associated with improved levels of knowledge and high satisfaction in parents. J Genet Couns 2020; 30:710-719. [PMID: 33179831 DOI: 10.1002/jgc4.1357] [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: 02/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/28/2022]
Abstract
Previous surveys of adults with cancer have revealed increased levels of genetic knowledge, varying levels of worry, and high satisfaction with cancer genetic counseling. We sought to determine the impact of cancer genetic counseling on parental levels of genetic knowledge, worry about cancer, and satisfaction in the context of suspected cancer predisposition in a child. We hypothesized that parents would be satisfied with cancer genetic counseling and that cancer genetic counseling would improve baseline parental genetic knowledge and decrease levels of worry. Parents were recruited from a pediatric cancer predisposition clinic in the United States. A survey was administered to two cohorts: One cohort had received cancer genetic counseling in the past and only completed one survey (post-only, n = 26), and another cohort completed the survey before and after cancer genetic counseling (pre/post, n = 23). The survey included questions on demographics, knowledge of genetics, worry levels, and satisfaction with the cancer genetic counseling service. The post-genetic counseling survey also contained a free-text section for parents to indicate what they took away from the sessions. Parental levels of genetics knowledge increased by an average of 1.9 points (p = .01), with 65.2% of parents demonstrating an increase in genetics knowledge score. Average worry levels did not change significantly (p = .37), with 52.2% of parents indicating decreased worry, and 34.8% indicating increased worry. Overall, 91.8% of parents reported high levels of satisfaction. Our results show that cancer genetic counseling in a pediatric cancer predisposition clinic improves parental levels of genetics knowledge. Satisfaction rates suggest that parents find this service beneficial. These results demonstrate the positive impacts of cancer genetic counseling on parents of children in which a hereditary cancer syndrome is known or suspected.
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Affiliation(s)
| | - Bojana B Pencheva
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Kami W Schneider
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joyce Turner
- Children's National Health System Rare Disease Institute, Washington, DC, USA
| | - Christopher C Porter
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
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Segundo-Ribeiro M, Bacalá BT, Alvarenga WDA, Nascimento LC, McAllister M, Flória-Santos M. Adaptation and preliminary validation of the genetic counseling outcome scale (GCOS-24) in a Brazilian genetic counseling setting. Eur J Med Genet 2020; 63:104018. [DOI: 10.1016/j.ejmg.2020.104018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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Senter L, Austin JC, Carey M, Cho MT, Harris SL, Linnenbringer EL, MacFarlane IM, Pan VY, Quillin JM, Wynn J, Hooker GW. Advancing the genetic counseling profession through research: Identification of priorities by the National Society of Genetic Counselors research task force. J Genet Couns 2020; 29:884-887. [PMID: 32969094 DOI: 10.1002/jgc4.1330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/12/2022]
Abstract
To help advance research critical to the achievement of the National Society of Genetic Counselors' (NSGC) strategic objectives, coordination and prioritization of society resources are needed. NSGC convened a task force to advance research necessary for the achievement of our strategic objectives by reviewing existing society-supported research efforts identifying gaps in current research, and coordinating society resources, the task force was formed in order to coordinate and prioritize society resources to advance research critical to the achievement of our strategic objectives. The task force developed a research agenda outlining high-priority research questions for the next 5 years. The questions are organized into four domains: (a) Genetic Counseling Clients; (b) Genetic Counseling Process and Outcomes; (c) Value of Genetic Counseling Services; and (d) Access to Genetic Counseling Services. This framework can be used to advocate for research and funding priorities within NSGC and with other key research entities to stimulate the growth and advancement of the genetic counseling profession.
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Affiliation(s)
- Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jehannine C Austin
- Departments of Psychiatry and Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meghan Carey
- National Society of Genetic Counselors, Chicago, Illinois, USA
| | - Megan T Cho
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Stephanie L Harris
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin L Linnenbringer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ian M MacFarlane
- Department of Psychology, Elizabethtown College, Elizabethtown, Pennsylvania, USA
| | | | - John M Quillin
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
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Smith HS, Swint JM, Lalani SR, de Oliveira Otto MC, Yamal JM, Russell HV, Lee BH. Exome sequencing compared with standard genetic tests for critically ill infants with suspected genetic conditions. Genet Med 2020; 22:1303-1310. [PMID: 32336750 DOI: 10.1038/s41436-020-0798-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE As exome sequencing (ES) is increasingly used as a diagnostic tool, we aimed to compare ES with status quo genetic diagnostic workup for infants with suspected genetic disorders in terms of identifying diagnoses, survival, and cost of care. METHODS We studied newborns and infants admitted to intensive care with a suspected genetic etiology within the first year of life at a US quaternary-referral children's hospital over 5 years. In this propensity-matched cohort study using electronic medical record data, we compared patients who received ES as part of a diagnostic workup (ES cohort, n = 368) with clinically similar patients who did not receive ES (No-ES cohort, n = 368). RESULTS Diagnostic yield (27.4% ES, 25.8% No-ES; p = 0.62) and 1-year survival (80.2% ES, 84.8% No-ES; p = 0.10) were no different between cohorts. ES cohort patients had higher cost of admission, diagnostic investigation, and genetic testing (all p < 0.01). CONCLUSION ES did not differ from status quo genetic testing collectively in terms of diagnostic yield or patient survival; however, it had high yield as a single test, led to complementary classes of diagnoses, and was associated with higher costs. Further work is needed to define the most efficient use of diagnostic ES for critically ill newborns and infants.
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Affiliation(s)
- Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - John M Swint
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | | - Jose-Miguel Yamal
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Heidi V Russell
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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Yuen J, Lee SY, Courtney E, Lim J, Soh H, Li ST, Chen Y, McAllister M, Fenwick EK, Ngeow J. Evaluating empowerment in genetic counseling using patient‐reported outcomes. Clin Genet 2019; 97:246-256. [DOI: 10.1111/cge.13646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Jeanette Yuen
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - Suat Y. Lee
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - Eliza Courtney
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - John Lim
- Biostatistics Unit, Department of Clinical Trials and Epidemiological SciencesNational Cancer Centre Singapore Singapore Singapore
| | - Hazel Soh
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - Shao T. Li
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - Yanni Chen
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
| | - Marion McAllister
- Centre for Medical Education, School of Medicine, Cardiff University Cardiff UK
| | - Eva K. Fenwick
- Health Services and Systems Research, Duke‐NUS Medical School Singapore Singapore
- Health Services Research Group, Singapore Eye Research Institute Singapore Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical OncologyNational Cancer Centre Singapore Singapore Singapore
- Oncology Academic Clinical Program, Duke‐NUS Medical School Singapore Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore Singapore
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Shickh S, Clausen M, Mighton C, Gutierrez Salazar M, Zakoor KR, Kodida R, Reble E, Elser C, Eisen A, Panchal S, Aronson M, Graham T, Armel SR, Morel CF, Fattouh R, Glogowski E, Schrader KA, Hamilton JG, Offit K, Robson M, Carroll JC, Isaranuwatchai W, Kim RH, Lerner-Ellis J, Thorpe KE, Laupacis A, Bombard Y. Health outcomes, utility and costs of returning incidental results from genomic sequencing in a Canadian cancer population: protocol for a mixed-methods randomised controlled trial. BMJ Open 2019; 9:e031092. [PMID: 31594892 PMCID: PMC6797333 DOI: 10.1136/bmjopen-2019-031092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Genomic sequencing has rapidly transitioned into clinical practice, improving diagnosis and treatment options for patients with hereditary disorders. However, large-scale implementation of genomic sequencing faces challenges, especially with regard to the return of incidental results, which refer to genetic variants uncovered during testing that are unrelated to the primary disease under investigation, but of potential clinical significance. High-quality evidence evaluating health outcomes and costs of receiving incidental results is critical for the adoption of genomic sequencing into clinical care and to understand the unintended consequences of adoption of genomic sequencing. We aim to evaluate the health outcomes and costs of receiving incidental results for patients undergoing genomic sequencing. METHODS AND ANALYSIS We will compare health outcomes and costs of receiving, versus not receiving, incidental results for adult patients with cancer undergoing genomic sequencing in a mixed-methods randomised controlled trial. Two hundred and sixty patients who have previously undergone first or second-tier genetic testing for cancer and received uninformative results will be recruited from familial cancer clinics in Toronto, Ontario. Participants in both arms will receive cancer-related results. Participants in the intervention arm have the option to receive incidental results. Our primary outcome is psychological distress at 2 weeks following return of results. Secondary outcomes include behavioural consequences, clinical and personal utility assessed over the 12 months after results are returned and health service use and costs at 12 months and 5 years. A subset of participants and providers will complete qualitative interviews about utility of incidental results. ETHICS AND DISSEMINATION This study has been approved by Clinical Trials Ontario Streamlined Research Ethics Review System that provides ethical review and oversight for multiple sites participating in the same clinical trial in Ontario.Results from the trial will be shared through stakeholder workshops, national and international conferences, and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03597165.
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Affiliation(s)
- Salma Shickh
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mariana Gutierrez Salazar
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kathleen-Rose Zakoor
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Rita Kodida
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Emma Reble
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christine Elser
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Andrea Eisen
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Seema Panchal
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Tracy Graham
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Randall Armel
- Familial Breast Ovarian Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Chantal F Morel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Fred A. Litwin Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ramzi Fattouh
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Kasmintan A Schrader
- Department of Molecular Oncology and Hereditary Cancer Program, BC Cancer Agency, Vancouver, British Columbia, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jada G Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Breast Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - June C Carroll
- Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for exceLlence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Raymond H Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Palliative Care, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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12
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Cost-effectiveness analysis of reflex testing for Lynch syndrome in women with endometrial cancer in the UK setting. PLoS One 2019; 14:e0221419. [PMID: 31469860 PMCID: PMC6716649 DOI: 10.1371/journal.pone.0221419] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Lynch syndrome is a hereditary cancer syndrome caused by constitutional pathogenic variants in the DNA mismatch repair (MMR) system, leading to increased risk of colorectal, endometrial and other cancers. The study aimed to identify the incremental costs and consequences of strategies to identify Lynch syndrome in women with endometrial cancer. Methods A decision-analytic model was developed to evaluate the relative cost-effectiveness of reflex testing strategies for identifying Lynch syndrome in women with endometrial cancer taking the NHS perspective and a lifetime horizon. Model input parameters were sourced from various published sources. Consequences were measured using quality-adjusted life years (QALYs). A cost-effectiveness threshold of £20 000/QALY was used. Results Reflex testing for Lynch syndrome using MMR immunohistochemistry and MLH1 methylation testing was cost-effective versus no testing, costing £14 200 per QALY gained. There was uncertainty due to parameter imprecision, with an estimated 42% chance this strategy is not cost-effective compared with no testing. Age had a significant impact on cost-effectiveness, with testing not predicted to be cost-effective in patients aged 65 years and over. Conclusions Testing for Lynch syndrome in younger women with endometrial cancer using MMR immunohistochemistry and MLH1 methylation testing may be cost-effective. Age cut-offs may be controversial and adversely affect implementation.
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Thomas C, McAllister M. Establishing the minimum clinically important difference for the Genetic Counseling Outcome Scale (GCOS-24). J Genet Couns 2019; 28:1003-1010. [PMID: 31361378 DOI: 10.1002/jgc4.1152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022]
Abstract
To establish the smallest change in genetic counseling outcome that is meaningful for patients, the aim of this study was to establish the Minimum Clinically Important Difference (MCID) for the Genetic Counseling Outcome Scale (GCOS-24). GCOS-24 is a patient-reported outcome measure for clinical genetics services. Secondary aims included understanding what patients deem important for reaching this score. Participants were 74 new patients recruited from the All Wales Medical Genetics Service, between April 2016 and December 2016. An anchor-based, global transition question methodology was used to identify the MCID, by asking participants how much meaningful change they experienced following their genetics appointment, and comparing this with GCOS-24 change scores. This ensured that the established score was clinically meaningful to patients. Comments from a free text response box were analyzed using qualitative thematic analysis. The mean score of the group who felt "a little better" was determined to be the MCID. The MCID was established to be a GCOS-24 score increase of 10.3 points after a clinical genetics appointment. This score was significantly different from the group "neutral" (0.64 points), using an independent samples t test. Themes identified as important for reaching the MCID included "future and family". These findings contribute to interpretability of GCOS-24 and provide some useful insights for genetic counseling service development.
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Affiliation(s)
- Charlene Thomas
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Marion McAllister
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
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14
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Roberts JS. Assessing the Psychological Impact of Genetic Susceptibility Testing. Hastings Cent Rep 2019; 49 Suppl 1:S38-S43. [PMID: 31268575 PMCID: PMC7026861 DOI: 10.1002/hast.1015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The expanded use of genetic testing raises key ethical and policy questions about possible benefits and harms for those receiving disease-risk information. As predictive testing for Huntington's was initiated in a clinical setting, survey research posing hypothetical test scenarios suggested that the vast majority of at-risk relatives wanted to know whether they carried a disease-causing mutation. However, only a small minority ultimately availed themselves of this opportunity. Many at-risk individuals concluded that a positive test result would be too psychologically overwhelming. A substantial literature suggests that individuals are often more resilient than anticipated in coping with many different health-related stresses. Much of my own work in the field has been through the Risk Evaluation & Education for Alzheimer's Disease study (REVEAL), a series of randomized clinical trials assessing the impact of genetic susceptibility testing on asymptomatic individuals at risk for Alzheimer's disease. Our experience in developing and implementing four successive, multisite trials provides some potentially useful lessons for the field. More people will be asking for their personal genetic information. Better understanding will help us decide when access is appropriate and how best to disclose results in a manner that supports adjustment to test findings and promotes use of genetic information to improve human health.
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15
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Voorwinden JS, Plantinga M, Krijnen W, Ausems M, Knoers N, Velthuizen M, Birnie E, Lucassen AM, van Langen IM, Ranchor AV. A validated PROM in genetic counselling: the psychometric properties of the Dutch version of the Genetic Counselling Outcome Scale. Eur J Hum Genet 2019; 27:681-690. [PMID: 30683928 DOI: 10.1038/s41431-018-0318-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022] Open
Abstract
Patient empowerment has been identified as a key outcome goal in genetic counselling, and a patient reported outcome measure (PROM) has been developed to measure empowerment in genetic services: the Genetic Counselling Outcome Scale (GCOS). Here we validate the GCOS for a large and diverse Dutch study sample of 2194 patients referred to two clinical genetic centres for counselling about a wide range of conditions (heart disease, neurological disorders, cancer, congenital syndromes, intellectual disability and prenatal pathology). Our results suggest that the GCOS consists of a hierarchical 6-factor structure, with a main scale for empowerment and six subscales: uncertainty about heredity, hope, negative emotions, knowledge about the condition, knowledge about genetic services and uncertainty about the treatment. Six of the original 24 GCOS items were removed due to low factor loadings and small inter-item correlations. Internal consistency and test-retest reliability of the main scale and most subscales were satisfactory. Convergent validity was confirmed by moderate positive and moderate/strong negative associations between the GCOS main scale and other validated outcome measures. Responsiveness was comparable to that of other validated outcome measures. We saw significant improvement in the GCOS main scale and all the subscales after the first genetic counselling session. This study contributes to the international validation process of the GCOS, with the ultimate goal of using this instrument as a PROM, with empowerment as an outcome measure, to evaluate and improve the quality of genetic counselling in various clinical genetics settings.
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Affiliation(s)
- Jan S Voorwinden
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mirjam Plantinga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim Krijnen
- Department of Statistics, University of Groningen, Groningen, The Netherlands
| | - Margreet Ausems
- Department of Genetics, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nine Knoers
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Genetics, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mary Velthuizen
- Department of Genetics, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke M Lucassen
- Faculty of Medicine, Department of Clinical Ethics and Law, University of Southampton, Southampton, UK
| | - Irene M van Langen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Payne K, Eden M. Measuring the economic value of genetic counselling. Eur J Med Genet 2018; 62:385-389. [PMID: 30557702 DOI: 10.1016/j.ejmg.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, M13 9PL, UK.
| | - Martin Eden
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, M13 9PL, UK
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17
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Grant PE, Pampaka M, Payne K, Clarke A, McAllister M. Developing a short-form of the Genetic Counselling Outcome Scale: The Genomics Outcome Scale. Eur J Med Genet 2018; 62:324-334. [PMID: 30496830 DOI: 10.1016/j.ejmg.2018.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
The Genetic Counselling Outcome Scale (GCOS-24) is a 24-item patient reported outcome measure for use in evaluations of genetic counselling and testing services. The aim of this study was to develop a short form of GCOS-24. The study comprised three phases. Phase I: Cognitive interviews were used to explore interpretability of GCOS-24 items and which GCOS-24 items were most valued by the target population. Phase II: The Graded Response Model was used to analyse an existing set of GCOS-24 responses (n = 395) to examine item discrimination. Phase III: Item Selection. Three principles guided the approach to item selection (i) Items with poor discriminative properties were not selected; (ii) To avoid redundancy, items capturing a similar outcome were not selected together; item information curves and cognitive interview findings were used to establish superior items. (iii) Rasch analysis was then used to determine the optimal scale. In Phase I, ten cognitive interviews were conducted with individuals affected by or at risk for a genetic condition, recruited from patient support groups. Analysis of interview transcripts identified twelve GCOS-24 items which were highly valued by participants. In Phase II, Graded Response Model item characteristic curves and item information curves were produced. In Phase III, findings from Phases I and II were used to select ten highly-valued items that perform well. Finally, items were iteratively removed and permutated to establish optimal fit statistics under the Rasch model. A six-item questionnaire with a five-point Likert Scale was produced (The Genomics Outcome Scale (GOS)). Correlation between GCOS-24 and GOS scores is high (r = 0.838 at 99% confidence), suggesting that GOS maintains the ability of GCOS-24 to capture empowerment, whilst providing a less burdensome scale for respondents. This study represents the first step in developing a preference-based measure which could be used in the evaluation of technologies and services used in genomic medicine.
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Affiliation(s)
- Peter E Grant
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Maria Pampaka
- Departments of Social Statistics (School of Social Science) and Education (School of Environment Education and Development), The University of Manchester, Manchester, UK
| | - Katherine Payne
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Angus Clarke
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Marion McAllister
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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18
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Scheuner MT, Russell MM, Chanfreau-Coffinier C, Peredo J, Yano EM, Hamilton AB, Lerner B, Provenzale D, Knight SJ, Voils CI. Stakeholders' views on the value of outcomes from clinical genetic and genomic interventions. Genet Med 2018; 21:1371-1380. [PMID: 30377384 DOI: 10.1038/s41436-018-0344-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Robust evidence about the value of clinical genomic interventions (CGIs), such as genetic/genomic testing or clinical genetic evaluation, is limited. We obtained stakeholders' perspectives on outcomes from CGIs to help inform their value. METHODS We used an adapted Delphi expert panel process. Two anonymous survey rounds assessed the value of 44 CGI outcomes and whether a third party should pay for them, with discussion in between rounds. RESULTS Sixty-six panelists responded to the first-round survey and 60 to the second. Policy-makers/payers gave the lowest ratings for value and researchers gave the highest. Patients/consumers had the most uncertainty about value and payment by a third party. Uncertainty about value was observed when evidence of proven health benefit was lacking, potential harms outweighed benefits for reproductive outcomes, and outcomes had only personal utility for individuals or family members. Agreement about outcomes for which a third party should not pay included prevention through surgery with unproven health benefits, establishing ancestry, parental consanguinity, and paternity. CONCLUSION Research is needed to understand factors contributing to uncertainty and stakeholder differences about the value of CGI outcomes. Reaching consensus will accelerate the creation of metrics to generate the evidence needed to inform value and guide policies that promote availability, uptake, and coverage of CGIs.
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Affiliation(s)
- Maren T Scheuner
- Department of Pediatrics, Division of Medical Genetics, University of California-San Francisco, San Francisco, CA, USA. .,San Francisco VA Healthcare System, San Francisco, CA, USA. .,VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.
| | - Marcia M Russell
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine Chanfreau-Coffinier
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Jane Peredo
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Sara J Knight
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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19
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Chou AF, Mulvihill J, Kaye C, Mann S, Williams MS, Williamson L. Developing a genetic services assessment tool to inform quality improvement efforts in state genetic service delivery. Genet Med 2018; 21:955-964. [PMID: 30214070 DOI: 10.1038/s41436-018-0141-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/09/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Institute of Medicine recommended the utilization of metrics to improve quality in health care, although they have rarely been used in genetics. This study developed and tested a set of metrics for a quality assessment tool for genetic services METHODS: A systematic review of literature, guidelines, and consensus statements identified candidate measures for a possible assessment tool. An expert panel conducted a modified Delphi technique to rank the metrics. Ratings were computed to generate a score for each metric, creating a set of metrics for consensus discussions, pilot testing, and feasibility testing in eight Midwestern states. RESULTS The panel reduced 61 candidate metrics to 21 for pilot testing in two states, which further limited and refined the set to 16 metrics. These 16 were categorized into five domains: service capacity, access to care, data systems, performance reporting, and workforce. Further feasibility testing in one Regional Genetics Collaborative identified the tool's usefulness and barriers to implementation. CONCLUSIONS These quality metrics for both clinical and public health genetics across the lifespan may help medical professionals and policymakers evaluate quality and cost-effectiveness of genetic services on a statewide basis and stimulate outcome-oriented, health services research in medical genetics and genomics.
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Affiliation(s)
- Ann F Chou
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
| | - John Mulvihill
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Celia Kaye
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Sylvia Mann
- Genomics Section, State of Hawaii Department of Health, Honolulu, Hawaii, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Lori Williamson
- Department of Genetic Counseling, University of Arkansas, Little Rock, Arkansas, USA
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20
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Abstract
In January 2017, a group of experts in prenatal genetics attended a workshop at the Society of Maternal-Fetal Medicine meeting to review the evidence behind the costs and cost-effectiveness of prenatal genetic testing. Over the past decade, prenatal genetic testing options have dramatically expanded to include additional options with cell-free DNA (cfDNA) screening, as well as increased diagnostic abilities through chromosomal microarray analysis (CMA), gene panels, whole exome sequencing, and other tests. With these expanding technologies, it is important to consider the options available as well as the cost effectiveness of their use. Other important considerations are the effects of movements toward value-based health care; the role of professional societies, commercial laboratories, and insurers; disparities that exist in prenatal genetic testing; and outcomes for both patients and health care systems. Workshop participants identified key areas of research to advance our understanding of the costs and cost-effectiveness of prenatal genetic testing, which include (1) understanding the short- and long-term costs to patients and to health care systems with prenatal genetic tests; (2) elucidating the short- and long-term health outcomes for parents and children that are important to consider when comparing one testing strategy to another; (3) understanding the value underlying prenatal genetic testing to individuals and health care systems; and (4) identifying disparities in prenatal genetic testing, reasons for these disparities, and how to minimize them.
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Affiliation(s)
- Teresa N. Sparks
- Department of Obstetrics, Gyncecology, and Reproductive Sciences; University of California, San Francisco, 550 16th St, San Francisco, CA 94143, United States
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology; Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97219, United States,Corresponding author. (A.B. Caughey)
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21
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Formulation of Genetic Counseling Format for Adult Bangladeshi Patients with Acute Myeloid Leukemia. GENETICS RESEARCH INTERNATIONAL 2018; 2018:1534090. [PMID: 29854467 PMCID: PMC5949166 DOI: 10.1155/2018/1534090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022]
Abstract
With the advancement of medical genetics, particular emphasis is given on the genetic counseling worldwide. In Bangladesh, genetic counseling services are not yet developed. Acute myeloid leukemia (AML) is a malignant disease of the myeloid cells of bone marrow. Like other malignant diseases, it may result from a mutation in the DNA. A genetic counseling format will educate the AML patients and provide appropriate medical and emotional support. The aim of this descriptive cross-sectional study was to develop a genetic counseling format for adult Bangladeshi patients with AML. Taking this into account, a draft format was prepared by reviewing relevant documents available online which was later analyzed by an expert panel through a group discussion and thus a proposed format was developed. To make the format effective in the perspective of Bangladeshi population, the proposed format was applied in counseling, and thus a final format was developed in the English language. This format will educate the counselors, clinicians, and patients about the utility and importance of the genetic counseling and genetic tests. Also, the patients feel comfort regarding the whole counseling process and going for postcounseling treatments and advice. Though it is written in English, it may be translated into mother tongue for better communication during counseling.
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22
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Slomp C, Morris E, Inglis A, Lehman A, Austin J. Patient outcomes of genetic counseling: Assessing the impact of different approaches to family history collection. Clin Genet 2018; 93:830-836. [DOI: 10.1111/cge.13176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C. Slomp
- Department of Psychiatry; University of British Columbia; Vancouver Canada
| | - E. Morris
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - A. Inglis
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - A. Lehman
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - J. Austin
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
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Patient-Centered Care in Breast Cancer Genetic Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020319. [PMID: 29439543 PMCID: PMC5858388 DOI: 10.3390/ijerph15020319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/30/2022]
Abstract
With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.
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Cragun D, Zierhut H. Development of FOCUS-GC: Framework for Outcomes of Clinical Communication Services in Genetic Counseling. J Genet Couns 2018; 27:33-58. [PMID: 29022205 PMCID: PMC5796847 DOI: 10.1007/s10897-017-0145-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/11/2017] [Indexed: 01/17/2023]
Abstract
Conceptual frameworks bring together existing theories and models in order to identify, consolidate, and fill in gaps between theory, practice, and evidence. Given the vast number of possible outcomes that could be studied in genetic counseling, a framework for organizing outcomes and postulating relationships between communication services and genetic counseling outcomes was sought. Through an iterative approach involving literature review, thematic analysis, and consolidation, outcomes and processes were categorized to create and define components of a conceptual framework. The final product, "Framework for Outcomes of Clinical commUnication Services" (FOCUS) contains the following domains: communication strategy; communication process measures; patient care experience, patient changes, patient health; and family changes. A website was created to allow easier access and ongoing modifications to the framework. In addition, a step-by-step guide and two examples were created to show flexibility in how the framework can be used. FOCUS may help in conceptualizing, organizing and summarizing outcomes research related to risk communication and counseling in genetic service delivery as well as other healthcare settings.
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Affiliation(s)
- Deborah Cragun
- Department of Global Health, University of South Florida, 3720 Spectrum Boulevard, IDRB 304, Tampa, FL, 33612, USA.
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Twin Cities, Minneapolis, MN, USA
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25
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D'Andrea E, Lagerberg T, De Vito C, Pitini E, Marzuillo C, Massimi A, Vacchio MR, Grammatico P, Villari P. Patient experience and utility of genetic information: a cross-sectional study among patients tested for cancer susceptibility and thrombophilia. Eur J Hum Genet 2018; 26:518-526. [PMID: 29374276 DOI: 10.1038/s41431-017-0083-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
We evaluated whether genetic tests with evidence of clinical and personal utility (i.e. APC and BRCA1/2 tests) are associated with higher satisfaction and a more positive perception of care experience than those with undefined utility (i.e. tests for thrombophilia). A cross-sectional survey was performed through telephone interviews to patients tested for deleterious variants in APC or BRCA1/2 genes, or for inherited thrombophilia (FV Leiden and/or FIIG20210A) during a 5-year period (2008-2012). Three aspects of patient experience were assessed: effective communication through pre- and post-test genetic counselling; collaboration between caregivers on the management of patient care; and impact of genetic testing on quality of life. Overall 237 patients had telephone interviews. Multivariate logistic regression analyses showed that patients tested for APC or BRCA1/2 variants were more likely to be satisfied with both pre- and post-test counselling than those tested for inherited thrombophilia (APC vs. thrombophilia, p = 0.039 and 0.005; BRCA1/2 vs. thrombophilia, p = 0.030 and <0.001). Patients tested for APC were more likely to report an improvement in quality of life than those for thrombophilia (OR = 2.97, 95%CI 1.14, 7.72; p = 0.025). A positive association was observed between patients who underwent BRCA1/2 testing, and self-perceived improvement in quality of life (OR = 1.41, 95%CI 0.74, 2.69; p = 0.294). Tests of undefined clinical and personal utility are associated with a lower degree of patient satisfaction with genetic counselling and no clear opinions on changes in quality of life compared with those with well-defined utility.
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Affiliation(s)
- Elvira D'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. .,Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Vacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Grammatico
- Laboratory of Medical Genetics, Department of Molecular Medicine, San Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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26
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Palumbo R. Exploring the Divide between Output and Outcome Measures in Health Care. JOURNAL OF HEALTH MANAGEMENT 2017. [DOI: 10.1177/0972063417727622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rocco Palumbo
- Research Fellow in Organizational Studies, University of Salerno, Fisciano, Italy
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Muñoz-Cabello P, García-Miñaúr S, Espinel-Vallejo ME, Fernández-Franco L, Stephens A, Santos-Simarro F, Lapunzina-Badía P, McAllister M. Translation and Cross-Cultural Adaptation with Preliminary Validation of GCOS-24 for Use in Spain. J Genet Couns 2017; 27:732-743. [DOI: 10.1007/s10897-017-0154-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
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Esquivel-Sada D, Nguyen MT. Diagnosis of rare diseases under focus: impacts for Canadian patients. J Community Genet 2017; 9:37-50. [PMID: 28733824 PMCID: PMC5752651 DOI: 10.1007/s12687-017-0320-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/03/2017] [Indexed: 11/06/2022] Open
Abstract
This paper presents an in-depth qualitative analysis of the impact of diagnosis on the lives of rare disease (RD) patients. While diagnosis may be described as a watershed step for RD patients, no extensive account of non-medical outcomes following a RD diagnosis exists within the literature. This study aims to fill this knowledge gap through an analysis of the impact of diagnosis on the lives of RD patients according to their personal experiences. Qualitative research was conducted in three provinces across Canada, with a total of 23 participants, both adult and parents of children with RD, diagnosed and not yet diagnosed. A thematic approach guided the analysis of the transcripts. The results reveal that the impacts of a RD diagnosis for both adults and paediatric patients are multifold, ranging from social to personal and medical impacts (including cases where etiological treatments for the diseases are non-existent). Furthermore, the results shed light on distinct factors that affect the scope of impacts of a diagnosis.
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Affiliation(s)
- Daphne Esquivel-Sada
- Centre of Genomics and Policy, Faculty of Medicine, Department of Human Genetics, McGill University, 740 Dr. Penfield Ave., Montreal, QC, H3A 0G1, Canada.
| | - Minh Thu Nguyen
- Centre of Genomics and Policy, Faculty of Medicine, Department of Human Genetics, McGill University, 740 Dr. Penfield Ave., Montreal, QC, H3A 0G1, Canada
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Sweet K, Sturm AC, Schmidlen T, McElroy J, Scheinfeldt L, Manickam K, Gordon ES, Hovick S, Scott Roberts J, Toland AE, Christman M. Outcomes of a Randomized Controlled Trial of Genomic Counseling for Patients Receiving Personalized and Actionable Complex Disease Reports. J Genet Couns 2017; 26:980-998. [PMID: 28345121 DOI: 10.1007/s10897-017-0073-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
There has been very limited study of patients with chronic disease receiving potentially actionable genomic based results or the utilization of genetic counselors in the online result delivery process. We conducted a randomized controlled trial on 199 patients with chronic disease each receiving eight personalized and actionable complex disease reports online. Primary study aims were to assess the impact of in-person genomic counseling on 1) causal attribution of disease risk, 2) personal awareness of disease risk, and 3) perceived risk of developing a particular disease. Of 98 intervention arm participants (mean age = 57.8; 39% female) randomized for in-person genomic counseling, 76 (78%) were seen. In contrast, control arm participants (n = 101; mean age = 58.5; 54% female) were initially not offered genomic counseling as part of the study protocol but were able to access in-person genomic counseling, if they requested it, 3-months post viewing of at least one test report and post-completion of the study-specific follow-up survey. A total of 64 intervention arm and 59 control arm participants completed follow-up survey measures. We found that participants receiving in-person genomic counseling had enhanced objective understanding of the genetic variant risk contribution for multiple complex diseases. Genomic counseling was associated with lowered participant causal beliefs in genetic influence across all eight diseases, compared to control participants. Our findings also illustrate that for the majority of diseases under study, intervention arm participants believed they knew their genetic risk status better than control arm subjects. Disease risk was modified for the majority during genomic counseling, due to the assessment of more comprehensive family history. In conclusion, for patients receiving personalized and actionable genomic results through a web portal, genomic counseling enhanced their objective understanding of the genetic variant risk contribution to multiple common diseases. These results support the development of additional genomic counseling interventions to ensure a high level of patient comprehension and improve patient-centered health outcomes.
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Affiliation(s)
- Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA.
- Division of Human Genetics, Ohio State University, 2001 Polaris Parkway, Columbus, OH, 43212, USA.
| | - Amy C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Tara Schmidlen
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
| | - Joseph McElroy
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, 43221, USA
| | - Laura Scheinfeldt
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Temple University, SERC Building, 1925 N. 12th St, Philadelphia, PA, 19122-1801, USA
| | - Kandamurugu Manickam
- Geisinger Health System, Genomic Medicine Institute, Precision Health Center, 190 Welles Street, Suite 128, Forty Fort, PA, 18704, USA
| | - Erynn S Gordon
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Genome Medical, Monterey, CA, 93940, USA
| | - Shelly Hovick
- School of Communication, Ohio State University, Columbus, OH, 43214, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Amanda Ewart Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Michael Christman
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
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Exploring the feasibility of delivering standardized genomic care using ophthalmology as an example. Genet Med 2017; 19:1032-1039. [DOI: 10.1038/gim.2017.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023] Open
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Kohler JN, Turbitt E, Biesecker BB. Personal utility in genomic testing: a systematic literature review. Eur J Hum Genet 2017; 25:662-668. [PMID: 28295040 DOI: 10.1038/ejhg.2017.10] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Researchers and clinicians refer to outcomes of genomic testing that extend beyond clinical utility as 'personal utility'. No systematic delineation of personal utility exists, making it challenging to appreciate its scope. Identifying empirical elements of personal utility reported in the literature offers an inventory that can be subsequently ranked for its relative value by those who have undergone genomic testing. A systematic review was conducted of the peer-reviewed literature reporting non-health-related outcomes of genomic testing from 1 January 2003 to 5 August 2016. Inclusion criteria specified English language, date of publication, and presence of empirical evidence. Identified outcomes were iteratively coded into unique domains. The search returned 551 abstracts from which 31 studies met the inclusion criteria. Study populations and type of genomic testing varied. Coding resulted in 15 distinct elements of personal utility, organized into three domains related to personal outcomes: affective, cognitive, and behavioral; and one domain related to social outcomes. The domains of personal utility may inform pre-test counseling by helping patients anticipate potential value of test results beyond clinical utility. Identified elements may also inform investigations into the prevalence and importance of personal utility to future test users.
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Affiliation(s)
- Jennefer N Kohler
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Diness BR, Overbeck G, Hjortshøj TD, Hammer TB, Timshel S, Sørensen E, McAllister M. Translation and Adaptation of the Genetic Counselling Outcome Scale (GCOS-24) for Use in Denmark. J Genet Couns 2017; 26:1080-1089. [DOI: 10.1007/s10897-017-0086-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/21/2017] [Indexed: 11/28/2022]
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Willingness to Pay for a Newborn Screening Test for Spinal Muscular Atrophy. Pediatr Neurol 2017; 66:69-75. [PMID: 27769729 DOI: 10.1016/j.pediatrneurol.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/18/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The current US mandatory newborn screening panel does not include spinal muscular atrophy, the most common fatal genetic disease among children. We assessed population preferences for newborn screening for spinal muscular atrophy, and how test preferences varied depending on immediate treatment implications. METHODS We conducted an online willingness-to-pay survey of US adults (n = 982). Respondents were asked to imagine being parents of a newborn. Each respondent was presented with two hypothetical scenarios following the spinal muscular atrophy screening test: current standard of care (no treatment available) and one of three randomly assigned scenarios (new treatment available to improve functioning, survival, or both). We used a bidding game to elicit willingness to pay for the spinal muscular atrophy test, and performed a two-part model to estimate median and mean willingness-to-pay values. RESULTS Most respondents (79% to 87%) would prefer screening their newborns for spinal muscular atrophy. People expressed a willingness to pay for spinal muscular atrophy screening even without an available therapy (median: $142; mean: $253). Willingness to pay increased with treatment availability (median: $161 to $182; mean: $270 to $297) and respondent income. Most respondents considered test accuracy, treatment availability, and treatment effectiveness very important or important factors in deciding willingness to pay. CONCLUSIONS Most people would prefer and would be willing to pay for testing their newborn for spinal muscular atrophy, even in the absence of direct treatment. People perceive the spinal muscular atrophy test more valuable if treatment were available to improve the newborn's functioning and survival. Despite preferences for the test information, adding spinal muscular atrophy to newborn screening programs remains controversial. Future studies are needed to determine how early detection may impact long-term patient outcomes.
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Castejón V, Rovira T, Sumalla EC, Darder E, Iglesias S, Ochoa C, Blanco I. [Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer]. Med Clin (Barc) 2016; 146:148-54. [PMID: 26654557 DOI: 10.1016/j.medcli.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/27/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Having an inherited predisposition to cancer may have a psychological impact, and one goal of genetic counseling is to promote psychological adjustment to the new situation. Thus, in the genetic context, validated measures of adjustment are required. Given that self-concept is a good indicator of adjustment to the disease or to the risk for it, and a relevant variable in oncology, the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale. MATERIAL AND METHOD One hundred and sixty-five BRCA carriers' women answered to the questionnaire, previously adapted through a process of forward/back-translation, and to the Cancer Worry Scale (CWS) as a measure of convergent validity. Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges, and submitted to a confirmatory factor analysis (CFA). Cronbach's α was calculated for each subscale (Stigma, Vulnerability and Control), and correlations with CWS were performed. RESULTS Expert judges' structure and CFA do not support the original structure of the questionnaire. The respecificity model (with items 10 and 13 loading on Vulnerability factor) show a better fit: comparative fit index 0.973; Tucker-Lewis index 0.968; root mean square error of approximation 0.067. The Cronbach's α is 0.83 for Stigma, 0.84 for Vulnerability, and 0.61 for Control. Evidence of convergent validity with CWS has been obtained (Spearman's rho 0.631 for Stigma, 0.683 for Vulnerability, and -0.363 for Control; P<.001). CONCLUSIONS Results support the validity of the modified Spanish BRCA Self-Concept Scale, which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer.
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Affiliation(s)
- Vanessa Castejón
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Tatiana Rovira
- Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Enric C Sumalla
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Esther Darder
- Programa de Cáncer Hereditario, Institut Català d'Oncologia-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Unidad de Consejo Genético, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Silvia Iglesias
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Cristian Ochoa
- Unidad de Psico-Oncología, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, España
| | - Ignacio Blanco
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Programa de Asesoramiento y Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
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Christensen KD, Roberts JS, Whitehouse PJ, Royal CD, Obisesan TO, Cupples LA, Vernarelli JA, Bhatt DL, Linnenbringer E, Butson MB, Fasaye GA, Uhlmann WR, Hiraki S, Wang N, Cook-Deegan R, Green RC. Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: A Randomized Trial. Ann Intern Med 2016; 164:155-63. [PMID: 26810768 PMCID: PMC4979546 DOI: 10.7326/m15-0187] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Increasing use of genetic testing raises questions about disclosing secondary findings, including pleiotropic information. OBJECTIVE To determine the safety and behavioral effect of disclosing modest associations between apolipoprotein E (APOE) genotype and coronary artery disease (CAD) risk during APOE-based genetic risk assessments for Alzheimer disease (AD). DESIGN Randomized, multicenter equivalence clinical trial. (ClinicalTrials.gov: NCT00462917). SETTING 4 teaching hospitals. PARTICIPANTS 257 asymptomatic adults were enrolled, 69% of whom had 1 AD-affected first-degree relative. INTERVENTION Disclosure of genetic risk information about AD and CAD (AD+CAD) or AD only (AD-only). MEASUREMENTS Primary outcomes were Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores at 12 months. Secondary outcomes were all measures at 6 weeks and 6 months and test-related distress and health behavior changes at 12 months. RESULTS At 12 months, mean BAI scores were 3.5 in both the AD-only and AD+CAD groups (difference, 0.0 [95% CI, -1.0 to 1.0]), and mean CES-D scores were 6.4 and 7.1 in the AD-only and AD+CAD groups, respectively (difference, 0.7 [CI, -1.0 to 2.4]). Both confidence bounds fell within the equivalence margin of ±5 points. Among carriers of the APOE ε4 allele, distress was lower in the AD+CAD groups (difference, -4.8 [CI, -8.6 to -1.0]) (P = 0.031 for the interaction between group and APOE genotype). Participants in the AD+CAD groups also reported more health behavior changes, regardless of APOE genotype. LIMITATIONS Outcomes were self-reported by volunteers without severe anxiety, severe depression, or cognitive problems. Analyses omitted 33 randomly assigned participants. CONCLUSION Disclosure of pleiotropic information did not increase anxiety or depression and may have decreased distress among persons at increased risk for 2 conditions. Providing risk modification information about CAD improved health behaviors. Findings highlight the potential benefits of disclosure of secondary genetic findings when options exist for decreasing risk. PRIMARY FUNDING SOURCE National Human Genome Research Institute.
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Affiliation(s)
- Kurt D. Christensen
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - J. Scott Roberts
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Peter J. Whitehouse
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Charmaine D.M. Royal
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Thomas O. Obisesan
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - L. Adrienne Cupples
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Jacqueline A. Vernarelli
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Deepak L. Bhatt
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Erin Linnenbringer
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Melissa B. Butson
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Grace-Ann Fasaye
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Wendy R. Uhlmann
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Susan Hiraki
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Na Wang
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Robert Cook-Deegan
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Robert C. Green
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
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Eijzenga W, Bleiker EMA, Hahn DEE, Van der Kolk LE, Sidharta GN, Aaronson NK. Prevalence and detection of psychosocial problems in cancer genetic counseling. Fam Cancer 2015; 14:629-36. [PMID: 25968807 PMCID: PMC4630247 DOI: 10.1007/s10689-015-9809-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Only a minority of individuals who undergo cancer genetic counseling experience heightened levels of psychological distress, but many more experience a range of cancer genetic-specific psychosocial problems. The aim of this study was to estimate the prevalence of such psychosocial problems, and to identify possible demographic and clinical variables associated significantly with them. Consenting individuals scheduled to undergo cancer genetic counseling completed the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) prior to or immediately following their counseling session. More than half of the 137 participants reported problems on three or more domains of the PAHC, most often in the domains 'living with cancer' (84%), 'family issues' (46%), 'hereditary predisposition' (45%), and 'child-related issues' (42%). Correlations between the PAHC, the HADS and the DT were low. Previous contact with a psychosocial worker, and having a personal history of cancer were associated significantly with HADS scores, but explained little variance (9%). No background variables were associated significantly with the DT. Previous contact with a psychosocial worker, and having children were significantly associated with several PAHC domains, again explaining only a small percentage of the variance (2-14%). The majority of counselees experience specific cancer genetic counseling-related psychosocial problems. Only a few background variables are associated significantly with distress or psychosocial problems. Thus we recommend using the PAHC or a similar problem-oriented questionnaire routinely in cancer genetic counseling to identify individuals with such problems.
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Affiliation(s)
- W Eijzenga
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D E E Hahn
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Psychosocial Counseling, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L E Van der Kolk
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G N Sidharta
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Green RC, Christensen KD, Cupples LA, Relkin NR, Whitehouse PJ, Royal CDM, Obisesan TO, Cook-Deegan R, Linnenbringer E, Butson MB, Fasaye GA, Levinson E, Roberts JS. A randomized noninferiority trial of condensed protocols for genetic risk disclosure of Alzheimer's disease. Alzheimers Dement 2015; 11:1222-30. [PMID: 25499536 PMCID: PMC4461546 DOI: 10.1016/j.jalz.2014.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/12/2014] [Accepted: 10/30/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Conventional multisession genetic counseling is currently recommended when disclosing apolipoprotein E (APOE) genotype for the risk of Alzheimer's disease (AD) in cognitively normal individuals. The objective of this study was to evaluate the safety of brief disclosure protocols for disclosing APOE genotype for the risk of AD. METHODS A randomized, multicenter noninferiority trial was conducted at four sites. Participants were asymptomatic adults having a first-degree relative with AD. A standard disclosure protocol by genetic counselors (SP-GC) was compared with condensed protocols, with disclosures by genetic counselors (CP-GC) and by physicians (CP-MD). Preplanned co-primary outcomes were anxiety and depression scales 12 months after disclosure. RESULTS Three hundred and forty-three adults (mean age 58.3, range 33-86 years, 71% female, 23% African American) were randomly assigned to the SP-GC protocol (n = 115), CP-GC protocol (n = 116), or CP-MD protocol (n = 112). Mean postdisclosure scores on all outcomes were well below cut-offs for clinical concern across protocols. Comparing CP-GC with SP-GC, the 97.5% upper confidence limits at 12 months after disclosure on co-primary outcomes of anxiety and depression ranged from a difference of 1.2 to 2.0 in means (all P < .001 on noninferiority tests), establishing noninferiority for condensed protocols. Results were similar between European Americans and African Americans. CONCLUSIONS These data support the safety of condensed protocols for APOE disclosure for those free of severe anxiety or depression who are actively seeking such information.
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Affiliation(s)
- Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Partners Personalized Medicine, Boston, MA, USA.
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - L Adrienne Cupples
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Norman R Relkin
- Department of Neurology, Weill Medical College of Cornell University, New York, NY, USA
| | - Peter J Whitehouse
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Charmaine D M Royal
- Department of African and African American Studies, Duke University, Durham, NC, USA
| | - Thomas O Obisesan
- Department of Medicine, Howard University School of Medicine, Washington, DC, USA
| | | | - Erin Linnenbringer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Elana Levinson
- Department of Surgery, Columbia University, New York, NY, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Cuturilo G, Vucinic OK, Novakovic I, Ignjatovic S, Mijovic M, Sulovic N, Vukolic D, Komnenic M, Tadic J, Cetkovic A, Belic A, Ljubic A. Clients’ Perception of Outcome of Team-Based Prenatal and Reproductive Genetic Counseling in Serbian Service Using the Perceived Personal Control (PPC) Questionnaire. J Genet Couns 2015; 25:189-97. [DOI: 10.1007/s10897-015-9857-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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Redlinger-Grosse K, Veach PM, Cohen S, LeRoy BS, MacFarlane IM, Zierhut H. Defining Our Clinical Practice: The Identification of Genetic Counseling Outcomes Utilizing the Reciprocal Engagement Model. J Genet Couns 2015. [PMID: 26204965 DOI: 10.1007/s10897-015-9864-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The need for evidence-based medicine, including comparative effectiveness studies and patient-centered outcomes research, has become a major healthcare focus. To date, a comprehensive list of genetic counseling outcomes, as espoused by genetic counselors, has not been established and thus, identification of outcomes unique to genetic counseling services has become a priority for the National Society of Genetic Counselors (NSGC). The purpose of this study was to take a critical first step at identifying a more comprehensive list of genetic counseling outcomes. This paper describes the results of a focus group study using the Reciprocal-Engagement Model (REM) as a framework to characterize patient-centered outcomes of genetic counseling clinical practice. Five focus groups were conducted with 27 peer nominated participants who were clinical genetic counselors, genetic counseling program directors, and/or outcomes researchers in genetic counseling. Members of each focus group were asked to identify genetic counseling outcomes for four to five of the 17 goals of the REM. A theory-driven, thematic analysis of focus group data yielded 194 genetic counseling outcomes across the 17 goals. Participants noted some concerns about how genetic counseling outcomes will be measured and evaluated given varying stakeholders and the long-term nature of genetic concerns. The present results provide a list of outcomes for use in future genetic counseling outcomes research and for empirically-supported clinical interventions.
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Affiliation(s)
- Krista Redlinger-Grosse
- Department of Educational Psychology, University of Minnesota, 250 Education Sciences Building, 56 E. River Road, Minneapolis, MN, 55455, USA.
| | - Patricia McCarthy Veach
- Department of Educational Psychology, University of Minnesota, 250 Education Sciences Building, 56 E. River Road, Minneapolis, MN, 55455, USA
| | - Stephanie Cohen
- Cancer Genetics Risk Assessment Program, St. Vincent Hospital, Indianapolis, IN, USA
| | - Bonnie S LeRoy
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
| | | | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
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Gargon E, Williamson PR, Clarke M. Collating the knowledge base for core outcome set development: developing and appraising the search strategy for a systematic review. BMC Med Res Methodol 2015; 15:26. [PMID: 25888523 PMCID: PMC4395975 DOI: 10.1186/s12874-015-0019-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COMET (Core Outcome Measures in Effectiveness Trials) Initiative is developing a publicly accessible online resource to collate the knowledge base for core outcome set development (COS) and the applied work from different health conditions. Ensuring that the database is as comprehensive as possible and keeping it up to date are key to its value for users. This requires the development and application of an optimal, multi-faceted search strategy to identify relevant material. This paper describes the challenges of designing and implementing such a search, outlining the development of the search strategy for studies of COS development, and, in turn, the process for establishing a database of COS. METHODS We investigated the performance characteristics of this strategy including sensitivity, precision and numbers needed to read. We compared the contribution of databases towards identifying included studies to identify the best combination of methods to retrieve all included studies. RESULTS Recall of the search strategies ranged from 4% to 87%, and precision from 0.77% to 1.13%. MEDLINE performed best in terms of recall, retrieving 216 (87%) of the 250 included records, followed by Scopus (44%). The Cochrane Methodology Register found just 4% of the included records. MEDLINE was also the database with the highest precision. The number needed to read varied between 89 (MEDLINE) and 130 (SCOPUS). CONCLUSIONS We found that two databases and hand searching were required to locate all of the studies in this review. MEDLINE alone retrieved 87% of the included studies, but actually 97% of the included studies were indexed on MEDLINE. The Cochrane Methodology Register did not contribute any records that were not found in the other databases, and will not be included in our future searches to identify studies developing COS. SCOPUS had the lowest precision rate (0.77) and highest number needed to read (130). In future COMET searches for COS a balance needs to be struck between the work involved in screening large numbers of records, the frequency of the searching and the likelihood that eligible studies will be identified by means other than the database searches.
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Affiliation(s)
- Elizabeth Gargon
- Department of Biostatistics, University of Liverpool, Liverpool, UK.
| | | | - Mike Clarke
- All Ireland Hub for Trials Methodology Research, Queen's University Belfast, Belfast, UK.
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Design and implementation of a randomized controlled trial of genomic counseling for patients with chronic disease. J Pers Med 2015; 4:1-19. [PMID: 24926413 PMCID: PMC4051230 DOI: 10.3390/jpm4010001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We describe the development and implementation of a randomized controlled trial to investigate the impact of genomic counseling on a cohort of patients with heart failure (HF) or hypertension (HTN), managed at a large academic medical center, the Ohio State University Wexner Medical Center (OSUWMC). Our study is built upon the existing Coriell Personalized Medicine Collaborative (CPMC®). OSUWMC patient participants with chronic disease (CD) receive eight actionable complex disease and one pharmacogenomic test report through the CPMC® web portal. Participants are randomized to either the in-person post-test genomic counseling—active arm, versus web-based only return of results—control arm. Study-specific surveys measure: (1) change in risk perception; (2) knowledge retention; (3) perceived personal control; (4) health behavior change; and, for the active arm (5), overall satisfaction with genomic counseling. This ongoing partnership has spurred creation of both infrastructure and procedures necessary for the implementation of genomics and genomic counseling in clinical care and clinical research. This included creation of a comprehensive informed consent document and processes for prospective return of actionable results for multiple complex diseases and pharmacogenomics (PGx) through a web portal, and integration of genomic data files and clinical decision support into an EPIC-based electronic medical record. We present this partnership, the infrastructure, genomic counseling approach, and the challenges that arose in the design and conduct of this ongoing trial to inform subsequent collaborative efforts and best genomic counseling practices.
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McAllister M, Dearing A. Patient reported outcomes and patient empowerment in clinical genetics services. Clin Genet 2014; 88:114-21. [PMID: 25307491 DOI: 10.1111/cge.12520] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 12/20/2022]
Abstract
Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.
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Affiliation(s)
- M McAllister
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A Dearing
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Rogowski WH, Schleidgen S. Using needs-based frameworks for evaluating new technologies: an application to genetic tests. Health Policy 2014; 119:147-55. [PMID: 25488566 DOI: 10.1016/j.healthpol.2014.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 11/26/2022]
Abstract
Given the multitude of newly available genetic tests in the face of limited healthcare budgets, the European Society of Human Genetics assessed how genetic services can be prioritized fairly. Using (health) benefit maximizing frameworks for this purpose has been criticized on the grounds that rather than maximization, fairness requires meeting claims (e.g. based on medical need) equitably. This study develops a prioritization score for genetic tests to facilitate equitable allocation based on need-based claims. It includes attributes representing health need associated with hereditary conditions (severity and progression), a genetic service's suitability to alleviate need (evidence of benefit and likelihood of positive result) and costs to meet the needs. A case study for measuring the attributes is provided and a suggestion is made how need-based claims can be quantified in a priority function. Attribute weights can be informed by data from discrete-choice experiments. Further work is needed to measure the attributes across the multitude of genetic tests and to determine appropriate weights. The priority score is most likely to be considered acceptable if developed within a decision process which meets criteria of procedural fairness and if the priority score is interpreted as "strength of recommendation" rather than a fixed cut-off value.
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Affiliation(s)
- Wolf H Rogowski
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilians University, Ziemssenstraße 1, 80336 Munich, Germany.
| | - Sebastian Schleidgen
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University, Lessingstrasse 2, 80336 Munich, Germany.
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Kilambi V, Johnson FR, González JM, Mohamed AF. Valuations of genetic test information for treatable conditions: the case of colorectal cancer screening. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:838-45. [PMID: 25498779 PMCID: PMC4492688 DOI: 10.1016/j.jval.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND The value of the information that genetic testing services provide can be questioned for insurance-based health systems. The results of genetic tests oftentimes may not lead to well-defined clinical interventions; however, Lynch syndrome, a genetic mutation for which carriers are at an increased risk for colorectal cancer, can be identified through genetic testing, and meaningful health interventions are available via increased colonoscopic surveillance. Valuations of test information for such conditions ought to account for the full impact of interventions and contingent outcomes. OBJECTIVES To conduct a discrete-choice experiment to elicit individuals' preferences for genetic test information. METHODS A Web-enabled discrete-choice experiment survey was administered to a representative sample of US residents aged 50 years and older. In addition to specifying expenditures on colonoscopies, respondents were asked to make a series of nine selections between two hypothetical genetic tests or a no-test option under the premise that a relative had Lynch syndrome. The hypothetical genetic tests were defined by the probability of developing colorectal cancer, the probability of a false-negative test result, privacy of the result, and out-of-pocket cost. A model specification identifying necessary interactions was derived from assumptions of risk behavior and the decision context and was estimated using random-parameters logit. RESULTS A total of 650 respondents were contacted, and 385 completed the survey. The monetary equivalent of test information was approximately $1800. Expenditures on colonoscopies to reduce mortality risks affected valuations. Respondents with lower income or who reported being employed significantly valued genetic tests more. CONCLUSION Genetic testing may confer benefits through the impact of subsequent interventions on private individuals.
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Affiliation(s)
- Vikram Kilambi
- Center for Engineering and Health, Northwestern University, Evanston, IL, USA; Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC USA
| | - F Reed Johnson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | | | - Ateesha F Mohamed
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC USA
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Paneque M, Mendes Á, Guimarães L, Sequeiros J, Skirton H. Genetics Health Professionals' Views on Quality of Genetic Counseling Service Provision for Presymptomatic Testing in Late-Onset Neurological Diseases in Portugal: Core Components, Specific Challenges and the Need for Assessment Tools. J Genet Couns 2014; 24:616-25. [PMID: 25363284 DOI: 10.1007/s10897-014-9784-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/03/2014] [Indexed: 11/30/2022]
Abstract
Quality assessment of genetic counseling practice for improving healthcare is a challenge for genetic services worldwide; however, there is scarce literature regarding quality issues in genetic counseling in the context of presymptomatic testing for late-onset neurological diseases (Paneque et al. 2012) The aims of this qualitative study were to: (1) explore the views of professionals' who provide genetic counseling services for presymptomatic testing for late-onset neurological diseases regarding relevant quality indicators for counseling practice; and (2) examine current assessment of such counseling practice for Portuguese genetic services. Quality indicators are a means of measuring either the process or outcomes of patient services, with the aim of evaluating and improving quality of care (Mainz 2003). In this study, we defined quality indicators as measurable outcomes of the counseling process that may reflect good professional practice and desirable end-term effects. We undertook interviews with 18 genetic health professionals (85 % of all genetic counseling professionals involved) from the major genetic services in Portugal. Results indicate that professionals valued some core components of genetic counseling, including providing information and decision-making support, informing the consultand about the genetic counseling protocol, as well as exploring motivations, expectations for test results, consequent anticipated life changes, psychosocial adjustment, and personal and familial experience with the disease. Professionals were not, however, able to clearly elucidate quality indicators for effective practice and some reported they had not reflected on that topic before. Professionals also reported specific challenges in their practice, such as ambiguity of the health/illness status and affirming consultands' autonomy. Results of the study have revealed a lack of knowledge about quality indicators and tools to assess counseling practice. A credible set of quality indicators for presymptomatic testing is required as a foundation for the development of specific tools.
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Affiliation(s)
- M Paneque
- UnIGENe and Centre for Predictive and Preventive Genetics (CGPP), IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal,
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Eijzenga W, Bleiker EMA, Hahn DEE, Kluijt I, Sidharta GN, Gundy C, Aaronson NK. Psychosocial aspects of hereditary cancer (PAHC) questionnaire: development and testing of a screening questionnaire for use in clinical cancer genetics. Psychooncology 2014; 23:862-9. [PMID: 24443031 DOI: 10.1002/pon.3485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/24/2013] [Accepted: 12/19/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Up to three-quarters of individuals who undergo cancer genetic counseling and testing report psychosocial problems specifically related to that setting. The objectives of this study were to develop and evaluate the screening properties of a questionnaire designed to assess specific psychosocial problems related to cancer genetic counseling. METHODS We adopted the European Organisation for Research and Treatment of Cancer Quality of Life Group guidelines to develop the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire, a 26-item questionnaire organized into six problem domains: genetics, practical issues, family, living with cancer, emotions, and children. The Distress Thermometer and a question per domain on the perceived need for extra psychosocial services were included as well. We administered the questionnaire and the Hospital Anxiety and Depression Scale to 127 counselees at the time of genetic counseling and 3 weeks after DNA test disclosure. As a gold standard to evaluate the screening properties of the questionnaire, participants underwent a semi-structured interview with an experienced social worker who assessed the presence and severity of problems per domain. RESULTS A cutoff score representing responses of 'quite a bit' or 'very much' to one or more items within a given problem domain yielded moderate to high sensitivity across domains. A cutoff of 4 on the Distress Thermometer yielded high sensitivity. The questions regarding the perceived need for extra psychosocial services yielded high specificity and negative predictive values. CONCLUSION The Psychosocial Aspects of Hereditary Cancer questionnaire in combination with the Distress Thermometer can be used as a first-line screener for psychosocial problems within the cancer genetic counseling setting.
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Affiliation(s)
- W Eijzenga
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Rogowski WH, Grosse SD, Schmidtke J, Marckmann G. Criteria for fairly allocating scarce health-care resources to genetic tests: which matter most? Eur J Hum Genet 2014; 22:25-31. [PMID: 23921536 PMCID: PMC3865392 DOI: 10.1038/ejhg.2013.172] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/29/2013] [Accepted: 06/19/2013] [Indexed: 02/01/2023] Open
Abstract
The use of genetic tests is expanding rapidly. Given limited health-care budgets throughout Europe and few national coverage decisions specifically for genetic tests, decisions about allocating scarce resources to genetic tests are frequently ad hoc and left to lower-level decision makers. This study assesses substantive ethical and economic criteria to prioritize genetic services in a reasonable and fair manner. Principles for allocating health-care resources can be classified into four categories: need-based allocation; maximizing total benefits; treating people equally; and promoting and rewarding social usefulness. In the face of scarcity, the degree of an individual's need for medical intervention is an important criterion. Also, different economic concepts of efficiency are of relevance in the theory and practice of prioritizing genetic tests. Equity concerns are most likely to be relevant in terms of avoiding undesirable inequities, which may also set boundaries to the use of efficiency as a prioritization criterion. The aim of promoting and rewarding social usefulness is unlikely to be relevant to the question of what priority a genetic test should have in clinical practice. Further work is needed to select an appropriate set of criteria; operationalize them; and assign weights before some kind of standardized priority information can be added to information sources for genetic services. Besides the substantive criteria, formal considerations like those pointed out in the framework of accountability for reasonableness need to be considered in decision making.
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Affiliation(s)
- Wolf H Rogowski
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilians University, Munich, Germany
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jörg Schmidtke
- Institute for Human Genetics, Hanover Medical School, Hannover, Germany
| | - Georg Marckmann
- Institute for Ethics, History and Theory of Medicine, Ludwig Maximilians University, Munich, Germany
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Biesecker BB, Erby LH, Woolford S, Adcock JY, Cohen JS, Lamb A, Lewis KV, Truitt M, Turriff A, Reeve BB. Development and validation of the Psychological Adaptation Scale (PAS): use in six studies of adaptation to a health condition or risk. PATIENT EDUCATION AND COUNSELING 2013; 93:248-54. [PMID: 23993396 PMCID: PMC3810267 DOI: 10.1016/j.pec.2013.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 04/04/2013] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We introduce The Psychological Adaptation Scale (PAS) for assessing adaptation to a chronic condition or risk and present validity data from six studies of genetic conditions. METHODS Informed by theory, we identified four domains of adaptation: effective coping, self-esteem, social integration, and spiritual/existential meaning. Items were selected from the PROMIS "positive illness impact" item bank and adapted from the Rosenberg self-esteem scale to create a 20-item scale. Each domain included five items, with four sub-scale scores. Data from studies of six populations: adults affected with or at risk for genetic conditions (N=3) and caregivers of children with genetic conditions (N=3) were analyzed using confirmatory factor analyses (CFA). RESULTS CFA suggested that all but five posited items converge on the domains as designed. Invariance of the PAS amongst the studies further suggested it is a valid and reliable tool to facilitate comparisons of adaptation across conditions. CONCLUSION Use of the PAS will standardize assessments of adaptation and foster understanding of the relationships among related health outcomes, such as quality of life and psychological well-being. PRACTICE IMPLICATIONS Clinical interventions can be designed based on PAS data to enhance dimensions of psychological adaptation to a chronic health condition or risk.
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Affiliation(s)
- Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, USA; Health, Behavior and Society, Johns Hopkins Bloomberg, School of Public Health, Baltimore, USA.
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Pithara C. Identifying outcomes of clinical genetic services: qualitative evidence and methodological considerations. J Genet Couns 2013; 23:229-38. [PMID: 24037031 DOI: 10.1007/s10897-013-9654-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 08/29/2013] [Indexed: 11/24/2022]
Abstract
Extensive research into the tangible and intangible implications of Clinical Genetic Services (CGSs) has confirmed the relevance of a multidimensional outcome of benefit conceptually linked to perceived control. This paper aims to report qualitative findings from one small study aiming to add to the evidence pool confirming the relevance of such an outcome to participants from one UK clinical genetics center. Data were collected using focus groups and individual interviews with 22 service users from the following conditions: Hereditary Breast and Ovarian Cancer (HBOC), von Hippel Lindau disorder (VHL), Duchenne and Becker muscular dystrophy (DBMD), cystic fibrosis (CF) and tuberous sclerosis (TS). Transcripts were analyzed using thematic analysis and four dimensions of benefit were identified relating to cognitive, behavioral, social and emotional consequences. These dimensions related to an overarching conceptual outcome described as Perceived Familial Control. Findings are discussed to illustrate the inter-generational and intra-generational familial dimensions of CGSs and reinforce the significance of a familial focus to any genetics-specific outcome measure. The prospect and methodological considerations of a familial composite outcome measure for measuring overall benefit of CGSs is discussed based on current and past findings.
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Affiliation(s)
- Christalla Pithara
- Healthcare Management Program, Open University of Cyprus, P.O. Box 12794, 2252, Latsia, Cyprus,
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Eijzenga W, Hahn DEE, Aaronson NK, Kluijt I, Bleiker EMA. Specific psychosocial issues of individuals undergoing genetic counseling for cancer - a literature review. J Genet Couns 2013; 23:133-46. [PMID: 23996531 DOI: 10.1007/s10897-013-9649-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/12/2013] [Indexed: 01/02/2023]
Abstract
Approximately 25% of individuals undergoing genetic counseling for cancer experiences clinically relevant levels of distress, anxiety and/or depression. However, these general psychological outcomes that are used in many studies do not provide detailed information on the specific psychosocial problems experienced by counselees. The aim of this review was to investigate the specific psychosocial issues encountered by individuals undergoing genetic counseling for cancer, and to identify overarching themes across these issues. A literature search was performed, using four electronic databases (PubMed, PsychInfo, CINAHL and Embase). Papers published between January 2000 and January 2013 were selected using combinations, and related indexing terms of the keywords: 'genetic counseling', 'psychology' and 'cancer'. In total, 25 articles met our inclusion criteria. We identified the specific issues addressed by these papers, and used meta-ethnography to identify the following six overarching themes: coping with cancer risk, practical issues, family issues, children-related issues, living with cancer, and emotions. A large overlap in the specific issues and themes was found between these studies, suggesting that research on specific psychosocial problems within genetic counseling has reached a point of saturation. As a next step, efforts should be made to detect and monitor these problems of counselees at an early stage within the genetic counseling process.
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Affiliation(s)
- Willem Eijzenga
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
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