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Lascurain S, Thull D, Durst A, Bear T, Mai PL. Release of reclassified VUS results of now deceased patients to family members: Practices and opinions. J Genet Couns 2024. [PMID: 38189571 DOI: 10.1002/jgc4.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
Variants of uncertain significance (VUS) are commonly identified in genetic testing. The rate at which a VUS is reclassified depends on multiple factors. However, as the amount of time it might take for a VUS to be reclassified varies, some patients with a VUS genetic testing result might have passed away before the VUS is reclassified. A VUS that is reclassified after the patient's death has clinical implications for the deceased patient's family members. The disclosure of reclassified VUS results for a deceased patient has complex legal and ethical implications. There are no established guidelines on how the reclassified VUS result for a deceased patient should be disclosed to at-risk relatives. An online survey was sent to members of the National Society of Genetic Counselors (NSGCs) to elicit practices and opinions regarding this issue. A total of 153 (4%) NSGC members completed the survey. Thirty-seven (24.2%) respondents reported having received a reclassified VUS for a deceased patient. Respondents were more likely to attempt disclosure if the variant was reclassified as pathogenic (93.5%) versus benign (76.5%), although the difference did not reach statistical significance (p = 0.06). Respondents more often reported the impact on family members (85.5%) than the decedent's right to privacy (15.0%) as extremely important when considering disclosure to family members. A legal mechanism to allow disclosure to relatives was supported by 70.6% of respondents and 97.4% felt the issue was important enough to pursue if such a process was in place. Only 9.8% of respondents supported a legal requirement of consent before disclosing to family members when a VUS is reclassified after the patient has passed away. Our results indicate that there is no consensus for how these results should be handled and a mechanism for disclosure of reclassified results to family members is supported.
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Affiliation(s)
- Seth Lascurain
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darcy Thull
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Cancer Genetics Program, Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Andrea Durst
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd Bear
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Phuong L Mai
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Cancer Genetics Program, Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
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2
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Harrison C, Bartley N, Jacobs C, Best M, Vatter S, Meiser B, Ballinger ML, Thomas DM, Butow P. Family communication and results disclosure after germline sequencing: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2023; 114:107800. [PMID: 37210765 DOI: 10.1016/j.pec.2023.107800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Research on family communication of germline genome sequencing (GS) results (versus of genetic results after targeted genetic testing) is still emerging, yet potentially complex results increase the importance of communicating risk to relatives. Promoting equity by ensuring patients have sufficient health literacy to interpret results is important in this context. This study aimed to identify cancer patients' perceived importance of result disclosure, predictors of perceptions, and perspectives on family communication. METHODS This explanatory-sequential, cross-sectional mixed-methods study involved participants (n = 246) completing a questionnaire and (n = 20) a semi-structured interview. Ordinal logistic regressions determined associations between potential predictors and perceived importance of result disclosure. Interview transcripts were analysed thematically using a constant-comparative approach. RESULTS More participants intended disclosing to nuclear (77.4%) than to extended family (42.7%). More than half (59.3%) felt results were family information; 62.7% believed it was important to disclose results to family members. Nuclear and extended family communication scores and education level were significantly positively associated with perceived importance of disclosure (p < 0.05). Six qualitative themes were identified: i) Responsibility to inform, ii) Choice, iii) Autonomy, iv) Family Communication, v) Significance of results, and vi) Health professional role. CONCLUSION Low health literacy and family conflict can complicate communication of GS results. Patients seek clear, interpretable information in a format they can easily communicate. PRACTICE IMPLICATIONS Healthcare professionals can facilitate discussion of GS results by offering written information, encouraging disclosure, exploring existing family dynamics and communication patterns, and offering strategies to improve family communication. Centralised genetic communication offices and chatbots can also be helpful.
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Affiliation(s)
- Camelia Harrison
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Nicci Bartley
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Megan Best
- Institute for Ethics and Society, The University of Notre Dame, Sydney, Australia
| | - Sabina Vatter
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Bettina Meiser
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia; School of Psychology, Centre of Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, Australia.
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Patient and Family Preferences on Health System-Led Direct Contact for Cascade Screening. J Pers Med 2021; 11:jpm11060538. [PMID: 34200550 PMCID: PMC8230217 DOI: 10.3390/jpm11060538] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
Health benefits to relatives of people at known genetic risk for hereditary cancer syndromes is key to realizing the promise of precision medicine. We conducted a qualitative study to design a patient- and family-centered program for direct contact of relatives to recommend cascade genetic testing. We conducted two rounds of data collection using focus groups followed by individual interviews with patients with HBOC or Lynch syndrome and a separate sample of people with a family history of hereditary cancers. Results indicate that U.S.-based health system-led direct contact of relatives is acceptable to patients and families, should take a programmatic approach, include consent of relatives before proband testing, complement to existing patient-mediated disclosure, and allow for relative control of information. Our findings suggest a set of requirements for U.S.-based direct contact programs that could ultimately benefit more relatives than current approaches.
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Heuvel L, Smets E, Tintelen J, Christiaans I. How to inform relatives at risk of hereditary diseases? A mixed‐methods systematic review on patient attitudes. J Genet Couns 2019; 28:1042-1058. [DOI: 10.1002/jgc4.1143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L.M. Heuvel
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - J.P. Tintelen
- Department of Genetics University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - I. Christiaans
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
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Henrikson NB, Blasi PR, Fullerton SM, Grafton J, Leppig KA, Jarvik GP, Larson EB. "It would be so much easier": health system-led genetic risk notification-feasibility and acceptability of cascade screening in an integrated system. J Community Genet 2019; 10:461-470. [PMID: 30843145 PMCID: PMC6754469 DOI: 10.1007/s12687-019-00412-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/04/2019] [Accepted: 02/07/2019] [Indexed: 11/02/2022] Open
Abstract
Assess the feasibility and acceptability of health system-led genetic risk notification in a US integrated health system. We conducted semi-structured phone interviews with individuals age 40-64 years who had undergone genetic sequencing, but had not yet received their results, assessing attitudes to direct outreach to relatives. During each interview, we collected contact information for adult relatives identified as members of the same system and attempted to identify each relative in administrative data. We conducted 20 interviews. Most participants expressed support for Kaiser Permanente Washington involvement in familial risk notification. Direct outreach to relatives received the most unqualified support; outreach to the relatives' physician or interaction with the relatives' electronic medical record received more tempered support. Support was motivated by the desire to have risk communicated accurately and quickly. The most common caveat was a desire to alert relatives before the health system contacted them. Of 57 named relatives who were members of the same health system, we retrieved a single match for 40 (70.2%) based on name or birthdate. Health system involvement in familial risk notification received support in a sample of patients in a US integrated health system, and identification of relatives is feasible.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Pan JY, Haile RW, Templeton A, Macrae F, Qin F, Sundaram V, Ladabaum U. Worldwide Practice Patterns in Lynch Syndrome Diagnosis and Management, Based on Data From the International Mismatch Repair Consortium. Clin Gastroenterol Hepatol 2018; 16:1901-1910.e11. [PMID: 29702294 PMCID: PMC6440473 DOI: 10.1016/j.cgh.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/22/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Families with a history of Lynch syndrome often do not adhere to guidelines for genetic testing and screening. We investigated practice patterns related to Lynch syndrome worldwide, to ascertain potential targets for research and public policy efforts. METHODS We collected data from the International Mismatch Repair Consortium (IMRC), which comprises major research and clinical groups engaged in the care of families with Lynch syndrome worldwide. IMRC institutions were invited to complete a questionnaire to characterize diagnoses of Lynch syndrome and management practice patterns. RESULTS Fifty-five providers, representing 63 of 128 member institutions (49%) in 21 countries, completed the questionnaire. For case finding, 55% of respondents reported participating in routine widespread population tumor testing among persons with newly diagnosed Lynch syndrome-associated cancers, whereas 27% reported relying on clinical criteria with selective tumor and/or germline analyses. Most respondents (64%) reported using multigene panels for germline analysis, and only 28% reported testing tumors for biallelic mutations for cases in which suspected pathogenic mutations were not confirmed by germline analysis. Respondents reported relying on passive dissemination of information to at-risk family members, and there was variation in follow through of genetic testing recommendations. Reported risk management practices varied-nearly all programs (98%) recommended colonoscopy every 1 to 2 years, but only 35% recommended chemoprevention with aspirin. CONCLUSIONS There is widespread heterogeneity in management practices for Lynch syndrome worldwide among IMRC member institutions. This may reflect the rapid pace of emerging technology, regional differences in resources, and the lack of definitive data for many clinical questions. Future efforts should focus on the large numbers of high-risk patients without access to state-of-the-art Lynch syndrome management.
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Affiliation(s)
- Jennifer Y Pan
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California; Division of Gastroenterology, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Robert W Haile
- Department of Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allyson Templeton
- International Mismatch Repair Consortium, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Finlay Macrae
- Department of Medicine, University of Melbourne, Melbourne, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Uri Ladabaum
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
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Romero Arenas MA, Rich TA, Hyde SM, Busaidy NL, Cote GJ, Hu MI, Gagel RF, Gidley PW, Jimenez C, Kupferman ME, Peterson SK, Sherman SI, Ying A, Bassett RL, Waguespack SG, Perrier ND, Grubbs EG. Recontacting Patients with Updated Genetic Testing Recommendations for Medullary Thyroid Carcinoma and Pheochromocytoma or Paraganglioma. Ann Surg Oncol 2018; 25:1395-1402. [PMID: 29427212 PMCID: PMC10013431 DOI: 10.1245/s10434-018-6366-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND No guidelines exist regarding physicians' duty to inform former patients about novel genetic tests that may be medically beneficial. Research on the feasibility and efficacy of disseminating information and patient opinions on this topic is limited. METHODS Adult patients treated at our institution from 1950 to 2010 for medullary thyroid cancer, pheochromocytoma, or paraganglioma were included if their history suggested being at-risk for a hereditary syndrome but genetic risk assessment would be incomplete by current standards. A questionnaire assessing behaviors and attitudes was mailed 6 weeks after an information letter describing new genetic tests, benefits, and risks was mailed. RESULTS Ninety-seven of 312 (31.1%) eligible patients with an identified mailing address returned the questionnaire. After receiving the letter, 29.2% patients discussed genetic testing with their doctor, 39.3% considered pursuing genetic testing, and 8.5% underwent testing. Nearly all respondents (97%) indicated that physicians should inform patients about new developments that may improve their or their family's health, and 71% thought patients shared this responsibility. Most patients understood the letter (84%) and were pleased it was sent (84%), although 11% found it upsetting. CONCLUSIONS Patients believe it is important for physicians to inform them of potentially beneficial developments in genetic testing. However, physician-initiated letters to introduce new information appear inadequate alone in motivating patients to seek additional genetic counseling and testing. Further research is needed regarding optimal methods to notify former patients about new genetic tests and corresponding clinical and ethical implications.
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Affiliation(s)
- Minerva A Romero Arenas
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thereasa A Rich
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel M Hyde
- Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gilbert J Cote
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert F Gagel
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W Gidley
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Kupferman
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven I Sherman
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Ying
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Petersen HV, Frederiksen BL, Lautrup CK, Lindberg LJ, Ladelund S, Nilbert M. Unsolicited information letters to increase awareness of Lynch syndrome and familial colorectal cancer: reactions and attitudes. Fam Cancer 2018; 18:43-51. [DOI: 10.1007/s10689-018-0083-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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9
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Dheensa S, Fenwick A, Lucassen A. 'Is this knowledge mine and nobody else's? I don't feel that.' Patient views about consent, confidentiality and information-sharing in genetic medicine. JOURNAL OF MEDICAL ETHICS 2016; 42:174-9. [PMID: 26744307 PMCID: PMC4789809 DOI: 10.1136/medethics-2015-102781] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 11/09/2015] [Accepted: 12/07/2015] [Indexed: 05/24/2023]
Abstract
In genetic medicine, a patient's diagnosis can mean their family members are also at risk, raising a question about how consent and confidentiality should function in clinical genetics. This question is particularly pressing when it is unclear whether a patient has shared information. Conventionally, healthcare professionals view confidentiality at an individual level and 'disclosure without consent' as the exception, not the rule. The relational joint account model, by contrast, conceptualises genetic information as confidential at the familial level and encourages professionals to take disclosure as the default position. In this study, we interviewed 33 patients about consent and confidentiality and analysed data thematically. Our first theme showed that although participants thought of certain aspects of genetic conditions--for example, the way they affect day-to-day health--as somewhat personal, they perceived genetic information--for example, the mutation in isolation--as familial. Most thought these elements were separable and thought family members had a right to know the latter, identifying a broad range of harms that would justify disclosure. Our second theme illustrated that participants nonetheless had some concerns about what, if any, implications there would be of professionals treating such information as familial and they emphasised the importance of being informed about the way their information would be shared. Based on these results, we recommend that professionals take disclosure as the default position, but make clear that they will treat genetic information as familial during initial consultations and address any concerns therein.
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Affiliation(s)
- Sandi Dheensa
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anneke Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust
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10
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Heaton TJ, Chico V. Attitudes towards the sharing of genetic information with at-risk relatives: results of a quantitative survey. Hum Genet 2016; 135:109-20. [PMID: 26612611 PMCID: PMC4698294 DOI: 10.1007/s00439-015-1612-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/06/2015] [Indexed: 01/19/2023]
Abstract
To investigate public attitudes towards receiving genetic information arising from a test on a relative, 955 University of Sheffield students and staff were surveyed using disease vignettes. Strength of attitude was measured on whether, in the event of relevant information being discovered, they, as an at-risk relative, would want to be informed, whether the at-risk relative's interest should override proband confidentiality, and, if they had been the proband, willingness to give up confidentiality to inform such relatives. Results indicated considerably more complexity to the decision-making than simple statistical risk. Desire for information only slightly increased with risk of disease manifestation [log odds 0.05 (0.04, 0.06) per percentage point increase in manifestation risk]. Condition preventability was the primary factor increasing desire [modifiable baseline, non-preventable log odds -1.74 (-2.04, -1.44); preventable 0.64 (0.34, 0.95)]. Disease seriousness also increased desire [serious baseline, non-serious log odds -0.89 (-1.19, -0.59); fatal 0.55 (0.25, 0.86)]. Individuals with lower education levels exhibited much greater desire to be informed [GCSE log odds 1.67 (0.64, 2.66)]. Age did not affect desire. Our findings suggest that attitudes were influenced more by disease characteristics than statistical risk. Respondents generally expressed strong attitudes demonstrating that this was not an issue which people felt ambivalent about. We provide estimates of the British population in favour/against disclosure for various disease scenarios.
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Affiliation(s)
- Timothy J Heaton
- School of Mathematics and Statistics, University of Sheffield, Hicks Building, Hounsfield Road, Sheffield, S. Yorkshire, S3 7RH, UK.
| | - Victoria Chico
- School of Law, Bartolome House, University of Sheffield, Winter Street, Sheffield, S. Yorkshire, S3 7ND, UK
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11
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Dheensa S, Fenwick A, Shkedi-Rafid S, Crawford G, Lucassen A. Health-care professionals' responsibility to patients' relatives in genetic medicine: a systematic review and synthesis of empirical research. Genet Med 2015; 18:290-301. [PMID: 26110233 PMCID: PMC4823639 DOI: 10.1038/gim.2015.72] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/20/2015] [Indexed: 01/02/2023] Open
Abstract
Purpose: The extent of the responsibility of health-care professionals (HCPs) to ensure that patients' relatives are told of their risk is unclear. Current international guidelines take confidentiality to the individual patient as the default position, but some suggest that disclosure could be default and genetic information could be conceptualized as familial. Genet Med18 4, 290–301. Methods: Our systematic review and synthesis of 17 studies explored the attitudes of HCPs, patients, and the public regarding the extent of HCPs' responsibility to relatives with respect to disclosure. Genet Med18 4, 290–301. Results: Health-care professionals generally felt a responsibility to patients' relatives but perceived a variety of reasons why it would be difficult to act on this responsibility. Public/patient views were more wide-ranging. Participants identified several competing and overlapping arguments for and against HCP disclosure: guidelines do not permit/mandate it, privacy, medical benefit, impact on family dynamics, quality of communication, and respecting autonomy. Genet Med18 4, 290–301. Conclusion: We argue that HCPs can sometimes share genetic information without breaching confidentiality and that they could factor into their considerations the potential harm to family dynamics of nondisclosure. However, we need more nuanced research about their responsibilities to relatives, particularly as genomic tests are used more frequently in clinical practice. Genet Med18 4, 290–301.
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Affiliation(s)
- Sandi Dheensa
- Clinical Ethics and Law, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics and Law, University of Southampton, Southampton, UK
| | - Shiri Shkedi-Rafid
- Clinical Ethics and Law, University of Southampton, Southampton, UK.,Wessex Clinical Genetics Service, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Gillian Crawford
- Clinical Ethics and Law, University of Southampton, Southampton, UK.,Wessex Clinical Genetics Service, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Anneke Lucassen
- Clinical Ethics and Law, University of Southampton, Southampton, UK.,Wessex Clinical Genetics Service, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Giacomazzi CR, Giacomazzi J, Netto CB, Santos-Silva P, Selistre SG, Maia AL, Oliveira VZD, Camey SA, Goldim JR, Ashton-Prolla P. Pediatric cancer and Li-Fraumeni/Li-Fraumeni-like syndromes: a review for the pediatrician. Rev Assoc Med Bras (1992) 2015; 61:282-9. [DOI: 10.1590/1806-9282.61.03.282] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 10/17/2014] [Indexed: 11/21/2022] Open
Abstract
Summary Introduction: cancer is the second leading cause of death in children between the ages of 0 and 14 years, corresponding to approximately 3% of all cases diagnosed in Brazil. A significant percentage (5-10%) of pediatric cancers are associated with hereditary cancer syndromes, including Li-Fraumeni/Li-Fraumeni-like syndromes (LFS/LFL), both of which are caused by TP53 germline mutations. Recent studies have shown that a specific TP53 mutation, known as p.R337H, is present in 1 in 300 newborns in Southern and Southeast Brazil. In addition, a significant percentage of children with LFS/LFL spectrum tumors in the region have a family history compatible with LFS/LFL. Objective: to review clinical relevant aspects of LFS/LFL by our multidisciplinary team with focus on pediatric cancer. Methods: the NCBI (PubMed) and SciELO databases were consulted using the keywords Li-Fraumeni syndrome, Li-Fraumeni-like syndrome and pediatric cancer; and all manuscripts published between 1990 and 2014 using these keywords were retrieved and reviewed. Conclusion: although LFS/LFL is considered a rare disease, it appears to be substantially more common in certain geographic regions. Recognition of population- specific risks for the syndrome is important for adequate management of hereditary cancer patients and families. In Southern and Southeastern Brazil, LFS/ LFL should be considered in the differential diagnosis of children with cancer, especially if within the spectrum of the syndrome. Due to the complexities of these syndromes, a multidisciplinary approach should be sought for the counseling, diagnosis and management of patients and families affected by these disorders. Pediatricians and pediatric oncologists in areas with high prevalence of hereditary cancer syndromes have a central role in the recognition and proper referral of patients and families to genetic cancer risk evaluation and management programs.
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13
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Barrow P, Green K, Clancy T, Lalloo F, Hill J, Evans D. Improving the uptake of predictive testing and colorectal screening in Lynch syndrome: a regional primary care survey. Clin Genet 2015; 87:517-24. [DOI: 10.1111/cge.12559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 12/20/2022]
Affiliation(s)
- P. Barrow
- Department of Colorectal Surgery, Manchester Royal Infirmary; Manchester UK
| | - K. Green
- Manchester Centre for Genomic Medicine; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre (MAHSC); Manchester UK
| | - T. Clancy
- Manchester Centre for Genomic Medicine; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre (MAHSC); Manchester UK
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences; University of Manchester, MAHSC; Manchester UK
| | - F. Lalloo
- Manchester Centre for Genomic Medicine; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre (MAHSC); Manchester UK
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences; University of Manchester, MAHSC; Manchester UK
| | - J. Hill
- Department of Colorectal Surgery, Manchester Royal Infirmary; Manchester UK
| | - D.G. Evans
- Manchester Centre for Genomic Medicine; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre (MAHSC); Manchester UK
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences; University of Manchester, MAHSC; Manchester UK
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Rothenmund H, Singh H, Candas B, Chodirker BN, Serfas K, Aronson M, Holter S, Volenik A, Green J, Dicks E, Woods MO, Gilchrist D, Gryfe R, Cohen Z, Foulkes WD. Hereditary colorectal cancer registries in Canada: report from the Colorectal Cancer Association of Canada consensus meeting; Montreal, Quebec; October 28, 2011. ACTA ACUST UNITED AC 2013; 20:273-8. [PMID: 24155632 DOI: 10.3747/co.20.1566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At a consensus meeting held in Montreal, October 28, 2011, a multidisciplinary group of Canadian experts in the fields of genetics, gastroenterology, surgery, oncology, pathology, and health care services participated in presentation and discussion sessions for the purpose of developing consensus statements pertaining to the development and maintenance of hereditary colorectal cancer registries in Canada. Five statements were approved by all participants.
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Affiliation(s)
- H Rothenmund
- Hereditary Colorectal Cancer Registry, Cancer Prevention Centre, Jewish General Hospital, Montreal, QC
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Wiens ME, Wilson BJ, Honeywell C, Etchegary H. A family genetic risk communication framework: guiding tool development in genetics health services. J Community Genet 2013; 4:233-42. [PMID: 23319393 PMCID: PMC3666832 DOI: 10.1007/s12687-012-0134-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 12/20/2012] [Indexed: 12/20/2022] Open
Abstract
Family communication of genetic risk information is a complex process. Currently, there are no evidence-based interventions to help genetics professionals facilitate the process of disclosure within families. This study was designed to create a framework to assist in the development of tools to support patients in communicating genetic risk information to family members. A systematic review identified the factors relevant in communicating genetic risk information in families. A guiding theory for the proposed framework was selected and populated with the factors identified from the review. The review identified 112 factors of relevance. The theory of planned behaviour was selected to guide framework development, organising the framework in terms of the patient's attitudes about disclosure, perceived pressure to disclose and perceived control over disclosure. Attitudes about disclosure are influenced by a desire to protect oneself or family members, and the patient's perceptions of relevance of the information for family members, responsibility to disclose, family members' rights to information and the usefulness of communicating. Perceived pressure to disclose information is shaped by genetic professionals, family members and society. Perceived control over disclosure is affected by family relationships/dynamics, personal communication skills, the ability of the patient and family to understand the information and coping skills of the patient and family member. The family genetic risk communication framework presents a concise synthesis of the evidence on family communication of genetic information; it may be useful in creating and evaluating tools to help genetic counsellors and patients with communication issues.
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Affiliation(s)
- Miriam E Wiens
- CF Health Services Group Headquarters, Department of National Defence, 1745 Alta Vista Drive, Ottawa, ON, Canada, K1A 0K6,
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Hallowell N, Jenkins N, Douglas M, Walker S, Finnie R, Porteous M, Lawton J. Patients' experiences and views of cascade screening for familial hypercholesterolemia (FH): a qualitative study. J Community Genet 2011; 2:249-57. [PMID: 22109877 DOI: 10.1007/s12687-011-0064-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/08/2011] [Indexed: 11/26/2022] Open
Abstract
Familial DNA cascade screening for familial hypercholesterolemia (FH) has recently been introduced in Scotland. This study investigated index patients' experiences of DNA testing and mediating cascade screening. Thirty-eight patients with a clinical diagnosis of definite or possible FH who had undergone DNA testing in the lipid clinic took part in semi-structured qualitative interviews. All patients were positive about DNA screening being undertaken by familiar and trusted clinicians within the lipid clinic. Most patients had already cascaded close relatives for serum cholesterol testing following their attendance at the lipid clinic. Identified mutation carriers who had attended the genetics clinic (n = 15) for a cascading appointment described finding this consultation helpful because it identified other at-risk family members and provided them with tailored information for their relatives. Participants who expressed a preference said they favoured indirect (patient-mediated) methods of cascading as they considered indirect approaches to be less threatening to family members than direct clinical contact. We conclude that DNA screening and indirect familial cascading is perceived as highly acceptable to index patients with FH. However, while indirect cascading methods may be more acceptable to patients, they do not yield the same numbers as more direct methods. There is, therefore, a need for further systematic research to investigate patients', family members' and staff views of the acceptability of direct versus indirect methods of cascade screening.
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Affiliation(s)
- Nina Hallowell
- Institute of Health and Society, Newcastle University, Newcastle, UK,
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18
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Aronson M. Genetic Counseling for Hereditary Colorectal Cancer: Ethical, Legal, and Psychosocial Issues. Surg Oncol Clin N Am 2009; 18:669-85. [DOI: 10.1016/j.soc.2009.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Ceballos RM, Newcomb PA, Beasley JM, Peterson S, Templeton A, Hunt JR. Colorectal cancer cases and relatives of cases indicate similar willingness to receive and disclose genetic information. ACTA ACUST UNITED AC 2008; 12:415-20. [PMID: 18752450 DOI: 10.1089/gte.2008.0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Recent developments in genetic testing allow us to detect individuals with inherited susceptibility to some cancers. Genetic testing to identify carriers of cancer-related mutations may help lower risk by encouraging preventive behaviors and surveillance. This study assessed willingness of colon cancer cases and relatives to receive genetic information that may indicate an increased risk for cancer, to whom they would disclose genetic information, and whether receiving genetic test results may influence future prevention behaviors among individuals enrolled in the Seattle Colorectal Cancer Family Registry. METHODS Incident invasive colorectal cancer cases were identified from the Puget Sound Surveillance Epidemiology and End Results (SEER) registry. In 2007, a sequential sample of cases and relatives (n = 147) were asked to respond to a questionnaire addressing study aims. The questionnaire was administered during a baseline or 5-year follow-up interview. RESULTS Patterns of response to each statement were similar between colorectal cancer cases and relatives. Both colorectal cases (95%) and relatives (95%) reported willingness to receive genetic information. Nearly all participants would tell their doctor the results of a genetic test (99% of cases; 98% of relatives), and all married participants would tell their spouses. Cases (96%) anticipated being slightly more likely than relatives (90%) to change their cancer screening behavior, but this difference was not statistically significant (p = 0.33). CONCLUSIONS A high percentage of both colorectal cancer cases and relatives sampled from the Seattle Colorectal Cancer Family Registry are interested in identifying their genetic status, discussing their genetic status with their family and doctor, and adopting behavioral changes that may reduce cancer risk.
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Affiliation(s)
- Rachel M Ceballos
- School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
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Cassa CA, Schmidt B, Kohane IS, Mandl KD. My sister's keeper?: genomic research and the identifiability of siblings. BMC Med Genomics 2008; 1:32. [PMID: 18655711 PMCID: PMC2503988 DOI: 10.1186/1755-8794-1-32] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 07/25/2008] [Indexed: 11/15/2022] Open
Abstract
Background Genomic sequencing of SNPs is increasingly prevalent, though the amount of familial information these data contain has not been quantified. Methods We provide a framework for measuring the risk to siblings of a patient's SNP genotype disclosure, and demonstrate that sibling SNP genotypes can be inferred with substantial accuracy. Results Extending this inference technique, we determine that a very low number of matches at commonly varying SNPs is sufficient to confirm sib-ship, demonstrating that published sequence data can reliably be used to derive sibling identities. Using HapMap trio data, at SNPs where one child is homozygotic major, with a minor allele frequency ≤ 0.20, (N = 452684, 65.1%) we achieve 91.9% inference accuracy for sibling genotypes. Conclusion These findings demonstrate that substantial discrimination and privacy risks arise from use of inferred familial genomic data.
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Affiliation(s)
- Christopher A Cassa
- Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA.
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Syndromic colon cancer: lynch syndrome and familial adenomatous polyposis. Gastroenterol Clin North Am 2008; 37:47-72, vi. [PMID: 18313539 DOI: 10.1016/j.gtc.2007.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colon cancer, the third leading cause of mortality from cancer in the United States, afflicts about 150,000 patients annually. More than 10% of these patients exhibit familial clustering. The most common and well characterized of these familial colon cancer syndromes is hereditary nonpolyposis colon cancer syndrome (Lynch syndrome), which accounts for about 2% to 3% of all cases of colon cancer in the United States. We review the current knowledge of familial cancer syndromes, with an emphasis on Lynch syndrome and familial adenomatous polyposis.
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