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Jacobsen BG, Lauridsen MM, Grønkjaer LL. Knowledge needs in patients with Liver Disease: a qualitative study. BMC Nurs 2023; 22:406. [PMID: 37904130 PMCID: PMC10614374 DOI: 10.1186/s12912-023-01580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Knowledge is essential for patients' disease management strategies and a critical component of healthcare. The importance of increasing patients level of knowledge has become more widely acknowledge in liver disease management in recent years, but further studies are needed to address patients experiences of unmet knowledge needs to develop appropriate patient education strategies. Therefore, the aim of this study was to explore knowledge needs in patients' with liver disease of different etiology and severity. METHODS A qualitative study was designed and an inductive method was chosen. Thirty-three patients with liver disease of different etiology and severity were interviewed using a semi-structured interview guide. Content analysis was used as an inspiration to describe and compare patients' needs for knowledge across disease etiology and severity. The reporting followed consolidated criteria for reporting qualitative research. RESULTS The analysis generated three categories and nine subcategories. In general, the patients described lack of knowledge related to their liver disease, which made it difficult for them to manage their disease. Patients wished to be more involved in care and treatment of the liver disease. However, patients' had difficulties to assess and understand the importance of the information they received from healthcare professionals. Due to lack of knowledge, patients' had a misconception of the liver disease. Patients' had variation in knowledge needs depending on liver disease etiology and severity. CONCLUSION Within liver disease management, knowledge of patients' experiences is vital to meet patients' knowledge needs and to develop appropriate patient education strategies. Therefore, it is important to ascertain a patient-centered approach to accommodate patients' individual knowledge needs, involve patients in care and treatment, and insure understanding to strengthen their self-management and give the patients the necessary skills to manage their disease and everyday life. REGISTRATION NUMBER Open Science Framework registration DOI https://doi.org/10.17605/OSF.IO/W28RC .
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Affiliation(s)
- Birgitte Gade Jacobsen
- Department of Gastroenterology, University Hospital of South Denmark, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Mette Munk Lauridsen
- Department of Gastroenterology, University Hospital of South Denmark, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Lea Ladegaard Grønkjaer
- Department of Gastroenterology, University Hospital of South Denmark, Finsensgade 35, Esbjerg, 6700, Denmark.
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2
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Sobregrau P, Peri JM, Sánchez del Valle R, Molinuevo JL, Barra B, Pintor L. Psychiatric and Psychosocial Characteristics of a Cohort of Spanish Individuals Attending Genetic Counseling Due to Risk for Genetically Conditioned Dementia. J Alzheimers Dis Rep 2022; 6:461-478. [PMID: 36186729 PMCID: PMC9484134 DOI: 10.3233/adr-210067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive genetic tests are presently effective over several medical conditions, increasing the demand among patients and healthy individuals. Considering the psychological burden suspected familial dementia may carry on individuals, assessing personality, coping strategies, and mental health could aid clinicians in findings the appropriate time for delivering genetic test results and predict compliance regarding genetic counseling and expectations towards the genetic condition depending on the outcome. Objective: To describe the psychiatric, psychological, and coping characteristics of a sample of Spanish individuals at risk of familial dementia before genetic test results were given. Methods: We included 54 first degree relatives of patients diagnosed with Alzheimer’s disease, lobar frontotemporal degeneration, or prion diseases. The NEO-FFI-R, COPE, and HADS tests evaluated personality, coping strategies, and psychological distress, respectively. Results: Anxiety and depression were below the cut-off point for mild severity. Conscientiousness and Agreeableness were the most preponderant personality factors, while Neuroticism was the least. Positive reinterpretation and Acceptance were the most frequent coping strategies, and Denial and Alcohol and drug use were the least used. Ongoing medical pathologies increased depression, while psychiatric disorders worsened psychological distress. Conclusion: Contrary to our expectations, PICOGEN candidates showed psychological distress and personality traits within normative ranges, and the use of problem-focused coping strategies prevailed over avoidance coping strategies. Nevertheless, clinicians should pay particular attention to individuals attending genetic counseling who are women, aged, and present an ongoing psychiatric disorder and psychiatric history at inclusion to ensure their mental health and adherence throughout the process.
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Affiliation(s)
- Pau Sobregrau
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
| | - Josep M. Peri
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Raquel Sánchez del Valle
- Neurology Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Bernardo Barra
- Clínica Universidad de Los Andes, Servicio de Salud Mental, Santiago, Chile
- Psychiatric Department, School of Medicine, Andrés Bello University, Santiago, Chile
| | - Luís Pintor
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
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3
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TÜRKÇAPAR MH, KAHYA Y, ÇAPAR-TAŞKESEN T, IŞIK H. Managing life during the pandemic: communication strategies, mental health, and the ultimate toll of the COVID-19. Turk J Med Sci 2021; 51:3168-3181. [PMID: 34284533 PMCID: PMC8771019 DOI: 10.3906/sag-2106-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim The purpose of this review was to present the ultimate toll of the COVID-19 pandemic by focusing on the communication strategies and mental health. Materials and methods We unsystematically reviewed the studies published between 2020 and 2021 from databases such as Google Scholar, Web of Science and ScienceDirect. Firstly, “new-normal” life challenges during the pandemic were discussed along with the public risk communication strategies. Later, mental health problems, posttraumatic growth, and protective factors were reviewed. Results Literature highlighted that individuals mainly experience COVID-19 related fear, anxiety, stress, negative emotions and sleep problems. Furthermore, the rates of clinically significant depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder suggest an increase. Specifically, COVID-19 stress syndrome, loneliness, and sleep problems were associated with mental health problems in the pandemic. However, some individuals seem to be resilient to the COVID-19 trauma and experience posttraumatic growth. Brief online intervention studies are promising for reducing the emotional toll of the COVID-19 as well as for making individuals more resilient. Conclusion To conclude, the negative conditions of the pandemic seem to make some people, but not all, vulnerable to mental illness. In addition, framing the public warnings in an optimal emotional tone seems to be more effective to comply with the precautions.
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Affiliation(s)
- Mehmet Hakan TÜRKÇAPAR
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, AnkaraTurkey
| | - Yasemin KAHYA
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, AnkaraTurkey
| | - Tuğba ÇAPAR-TAŞKESEN
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, AnkaraTurkey
| | - Hatice IŞIK
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, AnkaraTurkey
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4
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Dahle Ommundsen RM, Strømsvik N, Hamang A. Assessing the relationship between patient preferences for recontact after BRCA1 or BRCA2 genetic testing and their monitoring coping style in a Norwegian sample. J Genet Couns 2021; 31:554-564. [PMID: 34716741 DOI: 10.1002/jgc4.1526] [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: 04/07/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Recontacting former patients regarding new genetic information is currently not standard care but might be implemented in the future. Little information is available on the implications of this practice from the point of view of former patients. The aim of this study was to investigate preferences for recontact when new genetic information becomes available among patients tested for BRCA pathogenic variants. We further wanted to investigate whether having a high or low information-seeking coping style (monitoring) impacts preferences. Preferences for recontact were assessed using a self-constructed questionnaire. The Threatening Medical Situations Inventory (TMSI) was used to measure monitoring coping style. The questionnaires were sent to 500 randomly selected patients who had previously been tested for BRCA pathogenic variants within the time frame 2001-2014 at one genetic clinic in Norway. We received 323 completed questionnaires. Most respondents wanted to be recontacted with advances in genetic medicine (81.1%) and to receive highly personalized updates. Genetic counselors/geneticists were believed to be most responsible for recontact. There was a significant relationship between being a high monitor and wanting recontact to learn about own cancer risk and receive ongoing support. Patients have a high interest in being recontacted. The findings indicated a tendency for high monitors to prefer more detailed and personalized information.
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Affiliation(s)
- Randi Marlene Dahle Ommundsen
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nina Strømsvik
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Medical Genetics, Northern Norway Familial Cancer Center, University Hospital of North-Norway, Tromsø, Norway
| | - Anniken Hamang
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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5
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Plamann K, McCarthy Veach P, LeRoy BS, MacFarlane IM, Petzel SV, Zierhut HA. Effects of monitoring versus blunting on the public's preferences for information in a hypothetical cancer diagnosis scenario. J Genet Couns 2020; 30:132-143. [PMID: 32583486 DOI: 10.1002/jgc4.1302] [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] [Indexed: 12/20/2022]
Abstract
Monitoring and blunting are coping styles that characterize how people respond when faced with personally threatening situations. High monitors tend to pay more attention to, scan for, and amplify threatening cues; high blunters tend to avoid information and seek distractions when faced with a threatening event. This study sought to investigate possible differential effects of monitoring and blunting coping styles on information preferences in a hypothetical cancer diagnosis scenario in the adult general public of Minnesota. In a survey administered at a large public venue (2016 Minnesota State Fair), participants were asked to imagine they carried a gene mutation and were diagnosed with colon cancer. They indicated their information preference [modified Cassileth Information Styles Questionnaire (MCISQ)], completed two coping style measures [Miller Behavioral Style Scale (MBSS) and Threatening Medical Situations Inventory (TMSI)], rated their perceived severity of colon cancer (low, moderate, high), and answered demographic questions. Eight hundred fifty-five individuals provided usable data. Participants classified as monitors on the TMSI had significantly higher MCISQ scores (i.e., preferred more information) than those classified as blunters (p = .004). Those scoring high on monitoring and low on blunting on the MBSS preferred significantly more information than those scoring high on both monitoring and blunting (p = .04). Linear regression analysis revealed being a monitor (TMSI), scoring high on monitoring (MBSS), rating colon cancer as more severe, and having a higher education level were significant positive predictors of MCISQ scores. Results suggest individual differences in coping style, perceived severity, and education level affect desire for information. Genetic counselors should consider these patient characteristics (e.g., asking patients about their information preferences) and tailor their approaches accordingly.
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Affiliation(s)
- Katie Plamann
- Department of Clinical Genomics, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Bonnie S LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Ian M MacFarlane
- Department of Psychology, Elizabethtown College, Elizabethtown, PA, USA
| | - Sue V Petzel
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota Medical Center - Fairview, Minneapolis, MN, USA
| | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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Hammersland MH, Aarsand AK, Sandberg S, Andersen J. Self-efficacy and self-management strategies in acute intermittent porphyria. BMC Health Serv Res 2019; 19:444. [PMID: 31269991 PMCID: PMC6607542 DOI: 10.1186/s12913-019-4285-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Acute intermittent porphyria (AIP) is an inherited metabolic disease with low clinical penetrance caused by mutations in the hydroxymethylbilane (HMBS) gene. Although most patients experience little or no symptoms, serious attacks may include excruciating pain, severe electrolyte disturbances, paresis, and respiratory failure. Several drugs and lifestyle factors are potential attack inducers and avoiding known triggers is important to avoid symptomatic disease in both patients and genetically predisposed carriers. Our aim in this study was to describe self-efficacy and self-management strategies in self-reported symptomatic and asymptomatic HMBS mutation carriers, and to elucidate motives for predictive genetic testing. Methods This is a cross-sectional retrospective survey with postal questionnaires. We received responses from 140 HMBS carriers for the general self-efficacy scale (GSES), study-specific questions about symptoms, self-management strategies and motives for genetic testing and satisfaction with the genetic counseling scale (SCS). Results The results indicated high levels of self-efficacy in these Norwegian HMBS mutation carriers. Both self-reported symptomatic and asymptomatic cases recorded changes in behavior after diagnosis, such as avoiding possible triggering drugs and aspiring recommended eating habits. They were in general satisfied with the genetic counseling they had received. The possibility to prevent disease and learn about the risk of their children was their most important motives to undergo genetic testing. Conclusions This study indicates that continuing to provide information, counseling and education is beneficial in AIP, and that HMBS mutation carriers, both those self-assessed as asymptomatic and as symptomatic, are using their knowledge to avoid triggering factors. Electronic supplementary material The online version of this article (10.1186/s12913-019-4285-9) contains supplementary material, which is available to authorized users.
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Abstract
In light of the tense and ongoing security situation in Israel, one important issue that needs to be analyzed and understood is the perception of terrorism threats. Most studies focused mainly on the psychological implications of terrorist acts; this study examines the complexity of the manner in which the individual perceives the threat of terrorism. In all, 40 Israeli adults (22 women and 18 men) were interviewed using semistructured in-depth interviews. Qualitative analysis indicates that the components of the perception of terrorism that construct the evaluation and subjective perception of the participants are as follows: (a) perception of control, which is a feeling of loss of control and helplessness due to uncertainty, inability to predict threats, and the vagueness of the threat; (b) perception of vulnerability to the threat, such as a feeling of vulnerability to and potential victimization by terrorism; and (c) perception of fear of terrorism that includes responses of fear, anxiety, feeling of danger, and emotional distress. In addition, gender differences were found in the analysis. The findings of this study help gain a better understanding as to how people perceive the threat of terrorism. The findings also enable an understanding of the complexity of living under ongoing terrorism threats and may assist in understanding how citizens cope with and adjust to this threat.
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8
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Gornick MC, Kurian AW, An LC, Fagerlin A, Jagsi R, Katz SJ, Hawley ST. Knowledge regarding and patterns of genetic testing in patients newly diagnosed with breast cancer participating in the iCanDecide trial. Cancer 2018; 124:4000-4009. [DOI: 10.1002/cncr.31731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/22/2018] [Accepted: 07/13/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Michele C. Gornick
- Department of Internal MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Allison W. Kurian
- Department of MedicineStanford University Stanford California
- Department of Health Research and PolicyStanford University Stanford California
| | - Lawrence C. An
- Department of Internal MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Angela Fagerlin
- Department of Population Health SciencesUniversity of Utah School of Medicine Salt Lake City Utah
| | - Reshma Jagsi
- Department of Radiation OncologyUniversity of Michigan Medical School Ann Arbor Michigan
| | - Steven J. Katz
- Department of Internal MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Sarah T. Hawley
- Department of Internal MedicineUniversity of Michigan Medical School Ann Arbor Michigan
- Ann Arbor VA Center for Clinical Management Research Ann Arbor Michigan
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9
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Di Mattei VE, Carnelli L, Bernardi M, Bienati R, Brombin C, Cugnata F, Rabaiotti E, Zambetti M, Sarno L, Candiani M, Gentilini O. Coping Mechanisms, Psychological Distress, and Quality of Life Prior to Cancer Genetic Counseling. Front Psychol 2018; 9:1218. [PMID: 30061853 PMCID: PMC6055025 DOI: 10.3389/fpsyg.2018.01218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/27/2018] [Indexed: 01/06/2023] Open
Abstract
Background: Breast Cancer susceptibility genes 1 and 2 are implicated in hereditary breast and ovarian cancer and women can test for the presence of these genes prior to developing cancer. The goal of this study is to examine psychological distress, quality of life, and active coping mechanisms in a sample of women during the pre-test stage of the genetic counseling process, considering that pre-test distress can be an indicator of post-test distress. We also wanted to identify if subgroups of women, defined based on their health status, were more vulnerable to developing distress during the genetic counseling process. Methods: This study included 181 female participants who accessed a Cancer Genetic Counseling Clinic. The participants were subdivided into three groups on the basis of the presence of a cancer diagnosis: Affected patients, Ex-patients, and Unaffected participants. Following a self-report questionnaire, a battery of tests was administered to examine psychological symptomatology, quality of life, and coping mechanisms. Results: The results confirm that the genetic counseling procedure is not a source of psychological distress. Certain participants were identified as being more vulnerable than others; in the pre-test phase, they reported on average higher levels of distress and lower quality of life. These participants were predominantly Ex-patients and Affected patients, who may be at risk of distress during the counseling process. Conclusions: These findings highlight that individuals who take part in the genetic counseling process are not all the same regarding pre-test psychological distress. Attention should be paid particularly to Ex-patients and Affected patients by the multidisciplinary treating team.
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Affiliation(s)
- Valentina E Di Mattei
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,Clinical and Health Psychology Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Hospital, Milan, Italy
| | - Letizia Carnelli
- Clinical and Health Psychology Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Martina Bernardi
- Language Abilities Department, University of Parma, Parma, Italy
| | - Rebecca Bienati
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuela Rabaiotti
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Milvia Zambetti
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lucio Sarno
- Clinical and Health Psychology Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Hospital, Milan, Italy.,Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy.,Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Oreste Gentilini
- Breast Surgery and Breast Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Viberg Johansson J, Segerdahl P, Ugander UH, Hansson MG, Langenskiöld S. Making sense of genetic risk: A qualitative focus-group study of healthy participants in genomic research. PATIENT EDUCATION AND COUNSELING 2018; 101:422-427. [PMID: 28947362 DOI: 10.1016/j.pec.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE It is well known that research participants want to receive genetic risk information that is about high risks, serious diseases and potential preventive measures. The aim of this study was to explore, by qualitative means, something less well known: how do healthy research participants themselves make sense of genetic risk information? METHOD A phenomenographic approach was chosen to explore research participants' understanding and assessment of genetic risk. We conducted four focus-group (N=16) interviews with participants in a research programme designed to identify biomarkers for cardiopulmonary disease. RESULTS Among the research participants, we found four ways of understanding genetic risk: as a binary concept, as an explanation, as revealing who I am (knowledge of oneself) and as affecting life ahead. CONCLUSION Research participants tend to understand genetic risk as a binary concept. This does not necessarily imply a misunderstanding of, or an irrational approach to, genetic risk. Rather, it may have a heuristic function in decision-making. PRACTICAL IMPLICATIONS Risk communication may be enhanced by tailoring the communication to the participants' own lay conceptions. For example, researchers and counselors should address risk in binary terms, maybe looking out for how individual participants search for threshold figures.
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Affiliation(s)
- Jennifer Viberg Johansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden.
| | - Pär Segerdahl
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden
| | | | - Mats G Hansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden
| | - Sophie Langenskiöld
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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11
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Bronner MB, Nguyen MH, Smets EMA, van de Ven AWH, van Weert JCM. Anxiety during cancer diagnosis: Examining the influence of monitoring coping style and treatment plan. Psychooncology 2017; 27:661-667. [PMID: 28976610 DOI: 10.1002/pon.4560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/16/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Studies on anxiety within oncology show a high prevalence of anxiety both during and after the course of the disease. However, little is known about factors that influence the level of anxiety in the diagnostic phase. This study examines the presence of anxiety during diagnosis and treatment planning and explores how a monitoring (ie, information seeking) coping style and the suggested treatment plan (ie, with or without chemotherapy) interact with anxiety. METHODS Anxiety scores (6-item State-Trait Anxiety Inventory) were collected from 81 colorectal cancer patients before and after their visit to the outpatient Gastrointestinal Oncological Center Amsterdam. A cut-off score (>44) was used to indicate highly anxious patients. RESULTS More than half (59%) of the patients were classified as highly anxious before consultation. Although anxiety scores significantly decreased after consultation (t = 3.149, P = .002), 37% of the patients remained highly anxious. Reductions in anxiety were specifically observed for patients with a higher monitoring coping style and patients for whom a treatment plan without chemotherapy was proposed. Interestingly, high monitors for whom treatment without chemotherapy was proposed showed a major decrease in anxiety, whereas low monitors for whom treatment starting with chemotherapy was proposed showed a great increase in anxiety. CONCLUSIONS The diagnostic phase is associated with high levels of anxiety. Distinct patterns of anxiety were identified, depending on patients' coping style and the suggested treatment plan. Remarkably, patients with a lower monitoring coping style became particularly anxious when they were advised to start treatment with chemotherapy.
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Affiliation(s)
- Madelon B Bronner
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Minh Hao Nguyen
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthony W H van de Ven
- Gastrointestinal Oncological Center Amsterdam (GIOCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
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12
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Lindgren P, Stadin M, Blomberg I, Nordin K, Sahlgren H, Ingvoldstad Malmgren C. Information about first-trimester screening and self-reported distress among pregnant women and partners - comparing two methods of information giving in Sweden. Acta Obstet Gynecol Scand 2017; 96:1243-1250. [PMID: 28742930 DOI: 10.1111/aogs.13195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/17/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Balanced information before prenatal diagnosis (PND) aims to help expectant parents to make an informed choice. However, it is important that the information does not increase the expectant parents' psychological distress. The aim was to examine psychological distress among expectant parents, before and after receiving information about PND, to evaluate the possible differences between two different procedures of information giving, and to evaluate the association between satisfaction with the information and psychological distress. MATERIAL AND METHODS A longitudinal design, based on questionnaire data from 380 expectant parents from four counties in Sweden. The measurement points; T1, before the information about PND was given and T2, 2 weeks after the prenatal screening or 15 weeks of gestation. The Hospital Anxiety and Depression Scale (HADS) and the Swedish version of the Cambridge Worrying Scale (CWS) measured psychological distress. The Satisfaction with Genetic Counseling Scale (SCS) measured satisfaction with information about PND. RESULTS The rate of psychological distress was stable among the pregnant women, but decreased among their partners, after the information was received. General anxiety and the social-medical dimension of pregnancy-related worry decreased among the participants who received information, using the more distinct two-stage process (group A), but was unchanged in group B (less distinct two-stage process). Health-related worry decreased in both groups, whereas relational worry and level of depressive symptoms were unchanged in both groups. CONCLUSION Information about PND does not increase the psychological distress among expectant parents. A more distinct two-stage process of information giving might even decrease their anxiety.
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Affiliation(s)
- Peter Lindgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Stadin
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Inger Blomberg
- Department of Obstetrics and Gynecology, Gävle Hospital, Gävle, Sweden
| | - Karin Nordin
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Hanna Sahlgren
- Department of Women's Health, Falun Hospital, Falun, Sweden
| | - Charlotta Ingvoldstad Malmgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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13
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Anxiety and depression symptoms among women attending group-based patient education courses for hereditary breast and ovarian cancer. Hered Cancer Clin Pract 2017; 15:2. [PMID: 28096903 PMCID: PMC5225510 DOI: 10.1186/s13053-016-0062-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women carrying BRCA-mutations are facing significant challenges, including decision making regarding surveillance and risk-reducing surgery. They often report that they are left alone with these important decisions. In order to enhance the genetic counselling session we organized a group-based patient education (GPE) course for women with BRCA-mutations. The study aims were to characterize women attending a group-based patient education (GPE) course for hereditary breast and ovarian cancer, consider the usefulness of the course, evaluate symptoms of anxiety and depression among the participants, and finally investigate whether their levels of anxiety and depression changed from before to after the course session. METHODS A prospective study was conducted. Two weeks before (T1) and 2 weeks after (T2) attending the GPE-course the participants received questionnaires by mail. We collected information on demographic- and medical variables, anxiety and depression using Hospital Anxiety and Depression Scale (HADS), self-efficacy using The Bergen Genetic Counseling Self-Efficacy scale (BGCSES) and coping style using the Threatening Medical Situations Inventory (TMSI). A total of N = 100 (77% response rate) women participated at baseline and 75 (58% response rate) also completed post-course assessment. RESULTS The mean level of anxiety symptoms was elevated among participants but decreased significantly during follow-up. Lower anxiety symptom levels were associated with "longer time since disclosure of gene test result", "higher levels of self-efficacy" and having experienced "loss of a close relative due to breast or ovarian cancer". Lower depression symptom levels were associated with "higher levels of education" and "loss of a close relative due to breast or ovarian cancer". CONCLUSION The women in this study seemed to benefit from the GPE course. Women newly diagnosed with a BRCA mutation who reported lower levels of self-efficacy and lower levels of education were more vulnerable. These women need special attention.
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Oberguggenberger A, Sztankay M, Morscher RJ, Sperner-Unterweger B, Weber I, Hubalek M, Kemmler G, Zschocke J, Martini C, Egle D, Dünser M, Gamper E, Meraner V. Psychosocial outcomes and counselee satisfaction following genetic counseling for hereditary breast and ovarian cancer: A patient-reported outcome study. J Psychosom Res 2016; 89:39-45. [PMID: 27663109 DOI: 10.1016/j.jpsychores.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/02/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We investigated the psychosocial consequences of genetic counseling and testing (GCT) for hereditary breast and ovarian cancer (HBOC) at follow-up in a "real-life" sample of counselees at an Austrian tertiary care center. METHODS The study cohort included counselees who had undergone genetic counseling for HBOC and completed a follow-up self-report questionnaire battery on psychosocial outcomes (quality of life, psychological distress, satisfaction with counseling and decisions). For comparison of distress, we recruited a reference sample of breast cancer survivors (BCS; n=665) who had not requested GCT in the same setting. RESULTS Overall, counselees did not exhibit increased levels of anxiety and depression when compared to BCS. No specific follow-up deleterious psychosocial consequences were detected among the former group. Of the 137 counselees, 22.6% and 9.8% experienced clinically relevant levels of anxiety and depression, respectively, at an average follow-up time of 1.8years. However, both anxiety and depression significantly decreased with time and were alike between counselees with and without cancer diagnosis. Follow-up cancer worry seems to be significantly higher among counselees who had not undergone genetic testing or were undecided about it than among counselees who had been tested. CONCLUSION Our results strongly support GCT as part of routine care for patients with HBOC. The risk factors of increased distress in specific subgroups of counselees, such as recent cancer diagnosis or uncertainty about testing, warrant further exploration and specific attention in clinical routines. Particularly, the psychological needs of undecided counselees warrant ongoing attention and potential follow-ups.
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Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Raphael Johannes Morscher
- Division of Human Genetics, Medical University of Innsbruck, Austria; Research Program for Receptor Biochemistry and Tumor Metabolism, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ingrid Weber
- Division of Human Genetics, Medical University of Innsbruck, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Zschocke
- Division of Human Genetics, Medical University of Innsbruck, Austria
| | - Caroline Martini
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Dünser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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15
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Fox L, Walsh JC, Morrison TG, O’ Gorman D, Ruane N, Mitchell C, Carey JJ, Coughlan R, McGuire BE. Cognitive Coping Style and the Effectiveness of Distraction or Sensation-Focused Instructions in Chronic Pain Patients. PLoS One 2016; 11:e0142285. [PMID: 27071028 PMCID: PMC4829147 DOI: 10.1371/journal.pone.0142285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 10/20/2015] [Indexed: 11/19/2022] Open
Abstract
AIM This study set out to investigate whether cognitive coping strategies that match participants' preferred coping style effectively reduce pain intensity and situational anxiety in a population of people with chronic pain. METHOD Chronic pain patients (N = 43) completed questionnaires on coping style, pain intensity, self-efficacy, and situational/trait anxiety. Participants were classified as Monitors (n = 16) or Blunters (n = 19) based on their Miller Behavioural Style Scale score. Participants were then provided with an audiotaped intervention in which they were instructed to focus on pain sensations or to engage in a distraction task and then to rate the pain intensity and their anxiety during and after the attentional focus and distraction conditions. The two interventions were each completed by all participants, having been presented in counterbalanced order. RESULTS Findings revealed that Monitors' level of anxiety decreased following a congruent (i.e., sensation-focused) intervention. No effects were obtained in terms of perceived pain. For blunters, however, their perceived levels of anxiety and pain did not attenuate following a congruent, distraction-focused intervention. CONCLUSION Among persons experiencing chronic pain, tailoring coping strategies to match an individual's preferred coping style--in particular, those with a high level of monitoring--may enhance the benefit of psychological approaches to management of anxiety.
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Affiliation(s)
- Lisa Fox
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Jane C. Walsh
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Todd G. Morrison
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - David O’ Gorman
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospitals, Galway, Ireland
| | - Nancy Ruane
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospitals, Galway, Ireland
| | - Caroline Mitchell
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospitals, Galway, Ireland
| | - John J. Carey
- Rheumatology Department, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Robert Coughlan
- Rheumatology Department, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- * E-mail:
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16
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Roussi P, Miller SM. Monitoring style of coping with cancer related threats: a review of the literature. J Behav Med 2014; 37:931-54. [PMID: 24488543 DOI: 10.1007/s10865-014-9553-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 01/16/2014] [Indexed: 12/11/2022]
Abstract
Building on the Cognitive-Social Health Information-Processing model, this paper provides a theoretically guided review of monitoring (i.e., attend to and amplify) cancer-related threats. Specifically, the goals of the review are to examine whether individuals high on monitoring are characterized by specific cognitive, affective, and behavioral responses to cancer-related health threats than individuals low on monitoring and the implications of these cognitive-affective responses for patient-centered outcomes, including patient-physician communication, decision-making and the development of interventions to promote adherence and adjustment. A total of 74 reports were found, based on 63 studies, 13 of which were intervention studies. The results suggest that although individuals high on monitoring are more knowledgeable about health threats, they are less satisfied with the information provided. Further, they tend to be characterized by greater perceived risk, more negative beliefs, and greater value of health-related information and experience more negative affective outcomes. Finally, individuals high on monitoring tend to be more demanding of the health providers in terms of desire for more information and emotional support, are more assertive during decision-making discussions, and subsequently experience more decisional regret. Psychoeducational interventions improve outcomes when the level and type of information provided is consistent with the individual's monitoring style and the demands of the specific health threat. Implications for patient-centered outcomes, in terms of tailoring of interventions, patient-provider communication, and decision-making, are discussed.
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Affiliation(s)
- Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece,
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17
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Dieng M, Watts CG, Kasparian NA, Morton RL, Mann GJ, Cust AE. Improving subjective perception of personal cancer risk: systematic review and meta-analysis of educational interventions for people with cancer or at high risk of cancer. Psychooncology 2014; 23:613-25. [PMID: 24420128 DOI: 10.1002/pon.3476] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Newly diagnosed patients with cancer require education about the disease, the available treatments and potential consequences of treatment. Greater understanding of cancer risk has been found to be associated with greater health-related quality of life, improved psychological adjustment and greater health-related behaviours. The aim of this sytematic review was to assess the effectiveness of educational interventions in improving subjective cancer risk perception and to appraise the quality of the studies. METHODS We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective observational studies. Eligible studies were identified via Medline, PsycINFO, AMED, CINAHL and Embase databases. After screening titles and abstracts, two reviewers independently assessed the eligibility of 206 full-text articles. RESULTS Forty papers were included in the review; the majority of studies were conducted among breast cancer patients (n = 29) and evaluated the effect of genetic counselling on personal perceived risk (n = 25). Pooled results from RCTs (n = 12) showed that, both in the short and long term, educational interventions did not significantly influence risk perception level (standardised mean difference 0.05, 95% CI -0.24-0.34; p = 0.74) or accuracy (odds ratio = 1.96, 95% CI: 0.61-6.25; p = 0.26). Only one RCT reported a short-term difference in risk ratings (p = 0.01). Of prospective observational studies (n = 28), many did demonstrate changes in the level of perceived risk and improved risk accuracy and risk ratings in both the short and long term. However, only one (of three) observational studies reported a short-term difference in risk ratings (p < = 0.003). CONCLUSION Further development and investigation of educational interventions using good quality, RCTs are warranted.
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Affiliation(s)
- Mbathio Dieng
- Cancer Epidemiology and Services Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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18
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Dorval M, Bouchard K, Chiquette J. Systematic review of educational tools used during the BRCA1/2 genetic testing process. Per Med 2014; 11:113-124. [DOI: 10.2217/pme.13.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review describes the characteristics of available educational tools used for BRCA1/2 genetic testing. To identify the tools, we conducted a systematic search in electronic databases, and contacted over 1000 cancer genetics professionals. This review is based on 68 tools from the USA, Canada, Australia, the UK, France and Ireland. The tools vary in format and scope depending on the genetic testing phase for which they are intended. We found that a wide diversity of educational materials are available and used for BRCA1/2 genetic testing around the world. However, a substantial number of tools fail to address important aspects of genetic testing.
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Affiliation(s)
- Michel Dorval
- Faculté de Pharmacie et Centre de Recherche sur le Cancer, Université Laval, Québec, QC, G1V 0A6, Canada
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
| | - Karine Bouchard
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
| | - Jocelyne Chiquette
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
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19
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McQueen A, Swank PR, Vernon SW. Examining patterns of association with defensive information processing about colorectal cancer screening. J Health Psychol 2013; 19:1443-58. [PMID: 23864072 DOI: 10.1177/1359105313493649] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To reduce negative psychological affect from information or behavior that is inconsistent with one's positive self-concept, individuals use a variety of defensive strategies. It is unknown whether correlates differ across defenses. We examined correlates of four levels of defensive information processing about colorectal cancer screening. Cross-sectional surveys were completed by a convenience sample of 287 adults aged 50-75 years. Defenses measures were more consistently associated with individual differences (especially avoidant coping styles); however, situational variables involving health-care providers also were important. Future research should examine changes in defenses after risk communication and their relative impact on colorectal cancer screening.
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Affiliation(s)
- Amy McQueen
- Washington University, School of Medicine, USA
| | - Paul R Swank
- University of Texas, School of Public Health, USA
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20
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Petersen HV, Ladelund S, Carlsson C, Nilbert M. Sense of coherence and self-concept in Lynch syndrome. Hered Cancer Clin Pract 2013; 11:7. [PMID: 23830140 PMCID: PMC3707857 DOI: 10.1186/1897-4287-11-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 06/23/2013] [Indexed: 12/16/2022] Open
Abstract
Objective Most individuals who learn about hereditary cancer manage well, but identification of subgroups who find this knowledge burdening would allow psychosocial intervention. The objective of the study was to assess sense of coherence (SOC) in individuals with Lynch syndrome with comparison to a general population and correlation to self-concept. Methods A total of 345 individuals with Lynch syndrome completed the 13-item SOC scale and the 20-item Lynch syndrome self-concept scale. SOC scores were compared to a general Danish population and were correlated to self-concept estimates in individuals with Lynch syndrome. Characteristics of subgroups with adverse scores were described. Results Individuals with Lynch syndrome reported SOC scores similar to the general population. SOC and self-concept correlated well with a correlation coefficient of −0.51. Subsets with convergent and divergent scores, which may reflect different effects from knowledge about hereditary cancer, were identified. Conclusion Individuals with Lynch syndrome report SOC scores similar to the general population. SOC and self-concept correlate well but allow identification of subset who report adverse outcome and may be relevant for targeted intervention.
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Affiliation(s)
- Helle Vendel Petersen
- Department of Oncology, Institute of Clinical Sciences, Lund University, Lund, Sweden.
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21
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Platten U, Rantala J, Lindblom A, Brandberg Y, Lindgren G, Arver B. The use of telephone in genetic counseling versus in-person counseling: a randomized study on counselees' outcome. Fam Cancer 2012; 11:371-9. [PMID: 22399327 PMCID: PMC3496516 DOI: 10.1007/s10689-012-9522-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Increased demand for genetic counseling services necessitates exploring alternatives to in-person counseling. Telephone counseling is a less time-consuming and more cost-effective alternative. So far there is insufficient evidence to support a pre-counseling telephone model. This randomized questionnaire study aims to evaluate the oncogenetic counseling process and to compare the impact of the initial part of the oncogenetic counseling, when conducted via telephone versus in-person. The aspects of evaluations were: patients' expectations, satisfaction and experiences of genetic counseling, worry for developing hereditary cancer and health related quality of life. A total of 215 participants representing several cancer syndromes were randomized to counseling via telephone or in-person. The questionnaires were completed before and after oncogenetic nurse counseling, and 1 year after the entire counseling process. Overall, a high satisfaction rate with the oncogenetic counseling process was found among the participants regardless of whether the oncogenetic nurse counseling was conducted by telephone or in-person. The results show that a considerable number of participants experienced difficulties with the process of creating a pedigree and dissatisfaction with information on surveillance and prevention. Affected participants reported lower levels in most SF-36 domains compared to non-affected and both groups reported lower levels as compared to a Swedish reference group. The results indicate that telephone pre-counseling works as well as in-person counseling. Emotional support during genetic counseling and information on recommended cancer prevention and surveillance should be improved.
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Affiliation(s)
- Ulla Platten
- Department of Oncology and Pathology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Johanna Rantala
- Department of Clinical Genetics, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Gunilla Lindgren
- Department of Clinical Genetics, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Brita Arver
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
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22
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Rothwell E, Kohlmann W, Jasperson K, Gammon A, Wong B, Kinney A. Patient outcomes associated with group and individual genetic counseling formats. Fam Cancer 2012; 11:97-106. [PMID: 22057473 PMCID: PMC7462715 DOI: 10.1007/s10689-011-9486-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identifying new methods to deliver cancer genetic counseling (GC) are needed to meet the growing interest in BRCA1/2 testing. The goal of this pilot feasibility study was designed to test the initial acceptability of group GC on selected patient outcomes (satisfaction, distress, perceived control) in a breast/ovarian cancer genetics clinic setting. Sixty-five participants at increased risk for hereditary breast/ovarian cancer (HBOC) agreed to participate in self-selected individual or group GC appointments. Forty-nine participants completed all study questionnaires and were included in the analyses. There were significant improvements for participants in both the individual and group GC formats with regard to perceived personal control, general psychological distress and cancer-specific psychological distress scores. Participants in both the individual and group formats reported high satisfaction scores on the Genetic Counseling Satisfaction Scale. Study results suggest that group GC may be feasible and acceptable to high-risk women.
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Affiliation(s)
- Erin Rothwell
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA.
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23
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Fantini-Hauwel C, Dauvier B, Arciszewski T, Antoine P, Manouvrier S. Genetic testing for hereditary cancer: effects of alexithymia and coping strategies on variations in anxiety before and after result disclosure. Psychol Health 2011; 26:855-73. [PMID: 21432729 DOI: 10.1080/08870446.2010.506575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study assessed the impact of the results of genetic testing for hereditary cancer from a multifactorial health psychology perspective, considering that emotional expression plays a key role in psychological adjustment. Measures of dispositional and transactional coping strategies, anxiety and alexithymia were filled out by 77 participants in a longitudinal study design. Statistical analyses were performed using general linear models and partial least squares path modelling, low-constraint methods that are particularly useful in the behavioural sciences. While anxiety levels prior to the result announcement were predictive of the distress experienced by noncarriers, considerable variability was observed for mutation carriers. Some subjects who had lower anxiety levels before the test displayed greater anxiety afterwards, but others seemed to anticipate the distress they would experience with the result that they showed a decrease in anxiety. The mutation carriers behaved as though their adaptive functioning were reshaped by the test result, independent of their disposition and previous emotional state, except in the case of alexithymia. Difficulty expressing emotions prior to genetic testing contributed to a similar difficulty after receiving the result, adding to the latter's emotional impact by promoting emotion-focused coping strategies and increasing distress.
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Affiliation(s)
- Carole Fantini-Hauwel
- Center for Research in Psychology of Cognition, Language and Emotion, Aix Marseille I University, France.
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Phelps C, Bennett P, Jones H, Hood K, Brain K, Murray A. The development of a cancer genetic-specific measure of coping: the GRACE. Psychooncology 2010; 19:847-54. [PMID: 19823974 DOI: 10.1002/pon.1629] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Generic measures of coping fail to capture the process of undergoing specific health processes such as cancer genetic risk assessment. The Genetic Risk Assessment Coping Evaluation (GRACE) has been developed to provide greater specificity of measurement. METHOD Based upon previous research findings, the GRACE measures the degree of stress associated with 11 recognised sources of stress for individuals undergoing the early stages of cancer genetic risk assessment, and the use of up to eight coping strategies they may elicit. This paper reports preliminary data from the piloting of the GRACE within a randomised trial of a coping intervention. RESULTS Of the 265 participants who completed and returned their baseline questionnaire (prior to being informed of their level of genetic risk), 257 completed the GRACE. The most highly endorsed sources of stress involved concerns relating to family members, endorsed by over 60% of respondents, and concerns about how the participants would cope if found to be at increased risk (59%). Participants made use of multiple coping strategies across different sources of stress. The most frequently reported coping strategies were emotion-focused, which may reflect the stage of the assessment process. CONCLUSION The completion rates for the matrix and specificity of responses provided suggest that the GRACE may be an acceptable measurement tool. Further data collection and validation is ongoing.
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Affiliation(s)
- C Phelps
- School of Psychology and Counselling, Swansea Metropolitan University, Wales, UK.
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25
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Ho SMY, Ho JWC, Bonanno GA, Chu ATW, Chan EMS. Hopefulness predicts resilience after hereditary colorectal cancer genetic testing: a prospective outcome trajectories study. BMC Cancer 2010; 10:279. [PMID: 20537192 PMCID: PMC2891641 DOI: 10.1186/1471-2407-10-279] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 06/11/2010] [Indexed: 11/25/2022] Open
Abstract
Background - Genetic testing for hereditary colorectal cancer (HCRC) had significant psychological consequences for test recipients. This prospective longitudinal study investigated the factors that predict psychological resilience in adults undergoing genetic testing for HCRC. Methods - A longitudinal study was carried out from April 2003 to August 2006 on Hong Kong Chinese HCRC family members who were recruited and offered genetic testing by the Hereditary Gastrointestinal Cancer Registry to determine psychological outcomes after genetic testing. Self-completed questionnaires were administered immediately before (pre-disclosure baseline) and 2 weeks, 4 months and 1 year after result disclosure. Using validated psychological inventories, the cognitive style of hope was measured at baseline, and the psychological distress of depression and anxiety was measured at all time points. Results - Of the 76 participating subjects, 71 individuals (43 men and 28 women; mean age 38.9 ± 9.2 years) from nine FAP and 24 HNPCC families completed the study, including 39 mutated gene carriers. Four patterns of outcome trajectories were created using established norms for the specified outcome measures of depression and anxiety. These included chronic dysfunction (13% and 8.7%), recovery (0% and 4.3%), delayed dysfunction (13% and 15.9%) and resilience (76.8% and 66.7%). Two logistic regression analyses were conducted using hope at baseline to predict resilience, with depression and anxiety employed as outcome indicators. Because of the small number of participants, the chronic dysfunction and delayed dysfunction groups were combined into a non-resilient group for comparison with the resilient group in all subsequent analysis. Because of low frequencies, participants exhibiting a recovery trajectory (n = 3 for anxiety and n = 0 for depression) were excluded from further analysis. Both regression equations were significant. Baseline hope was a significant predictor of a resilience outcome trajectory for depression (B = -0.24, p < 0.01 for depression); and anxiety (B = -0.11, p = 0.05 for anxiety). Conclusions - The current findings suggest that hopefulness may predict resilience after HCRC genetic testing in Hong Kong Chinese. Interventions to increase the level of hope may be beneficial to the psychological adjustment of CRC genetic testing recipients.
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Affiliation(s)
- Samuel M Y Ho
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Linnenbringer E, Roberts JS, Hiraki S, Cupples LA, Green RC. "I know what you told me, but this is what I think:" perceived risk of Alzheimer disease among individuals who accurately recall their genetics-based risk estimate. Genet Med 2010; 12:219-27. [PMID: 20139767 PMCID: PMC2921681 DOI: 10.1097/gim.0b013e3181cef9e1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study evaluates the Alzheimer disease risk perceptions of individuals who accurately recall their genetics-based Alzheimer disease risk assessment. METHODS Two hundred forty-six unaffected first-degree relatives of patients with Alzheimer disease were enrolled in a multisite randomized controlled trial examining the effects of communicating APOE genotype and lifetime Alzheimer disease risk information. RESULTS Among the 158 participants who accurately recalled their Alzheimer disease risk assessment 6 weeks after risk disclosure, 75 (47.5%) believed their Alzheimer disease risk was more than 5% points different from the Alzheimer disease risk estimate they were given. Within this subgroup, 69.3% believed that their Alzheimer disease risk was higher than what they were told (discordant high), whereas 30.7% believed that their Alzheimer disease risk was lower (discordant low). Participants with a higher baseline risk perception were more likely to have a discordant-high risk perception (P < 0.05). Participants in the discordant-low group were more likely to be APOE epsilon4 positive (P < 0.05) and to score higher on an Alzheimer disease controllability scale (P < 0.05). CONCLUSION Our results indicate that even among individuals who accurately recall their Alzheimer disease risk assessment, many people do not take communicated risk estimates at face value. Further exploration of this clinically relevant response to risk information is warranted.
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Affiliation(s)
- Erin Linnenbringer
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan 48106-1248, USA.
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Roshanai AH, Rosenquist R, Lampic C, Nordin K. Does enhanced information at cancer genetic counseling improve counselees' knowledge, risk perception, satisfaction and negotiation of information to at-risk relatives?--a randomized study. Acta Oncol 2010; 48:999-1009. [PMID: 19636983 DOI: 10.1080/02841860903104137] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the present randomized intervention study was to investigate the effect of receiving extended cancer genetic information on counselees' knowledge, risk perception, information sharing and satisfaction with the service. METHODS In total, 147 counselees, affected by cancer and/or a family history of cancer, were randomized to extended or standard information. The levels of counselees' knowledge and personal risk estimations were measured at four time points. In addition, counselees' satisfaction with the counseling and sharing of the information to at-risk relatives was assessed. The intervention included meeting a specialist nurse, learning the breaking bad news method, receiving written material and video-taped counseling sessions. RESULTS A significant increase in the level of knowledge in participants in the "breast cancer group" regardless of the randomization was observed over time. The correct estimation of personal risk increased significantly in both groups after two weeks, but declined at the eight month follow-up. Most of the participants had informed at-risk relatives about their visit at the cancer genetic clinic. The majority of respondents in both groups were highly satisfied with the counseling. The only observed effects of the intervention were that counselees in the intervention group were significantly more satisfied with the content of the given information and with the way of informing relatives. CONCLUSION Apparently, the current genetic counseling is managed properly and extended information does not seem necessary in all cases. However, some counselees need additional sessions.
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van Rijssen HJ, Schellart AJM, Anema JR, van der Beek AJ. A theoretical framework to describe communication processes during medical disability assessment interviews. BMC Public Health 2009; 9:375. [PMID: 19807905 PMCID: PMC2765440 DOI: 10.1186/1471-2458-9-375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/06/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. OBJECTIVE The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. CONCLUSION The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments.
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DeMarco TA, Peshkin BN, Mars BD, Tercyak KP. Patient satisfaction with cancer genetic counseling: a psychometric analysis of the Genetic Counseling Satisfaction Scale. J Genet Couns 2009; 13:293-304. [PMID: 19736695 DOI: 10.1023/b:jogc.0000035523.96133.bc] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Satisfaction is an important patient reported outcome of genetic counseling, as it is one of the elements used by professional organizations and healthcare accrediting bodies to determine the quality of professional work. However, empirical research on patient satisfaction with genetic counseling has been limited, partly due to the lack of standardized measures available to assess this construct. The purpose of this study was to conduct a psychometric analysis of a new satisfaction measure, the Genetic Counseling Satisfaction Scale (GCSS), within a sample of women participating in a no-cost cancer genetic counseling and testing program. The sample consisted of 61 women undergoing counseling and testing for hereditary breast-ovarian cancer risk (BRCA1/2 testing) who completed the GCSS following pretest counseling. The results suggest that the GCSS was reliable (Cronbach's coefficient alpha = 0.90) and that participants were highly satisfied with the care they received. In addition, there were no differences in satisfaction between cancer genetic counseling and prenatal counseling participants (based on preexisting norms), and satisfaction did not vary by sociodemographic characteristics. Implications and recommendations are discussed.
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Affiliation(s)
- Tiffani A DeMarco
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Avenue, NW, Suite 317, Washington, District of Columbia 20007-4104, USA
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Helgesson G, Hansson MG, Ludvigsson J, Swartling U. Practical matters, rather than lack of trust, motivate non-participation in a long-term cohort trial. Pediatr Diabetes 2009; 10:408-12. [PMID: 19309450 DOI: 10.1111/j.1399-5448.2008.00498.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the importance of trust in researchers and other reasons that participating parents, former participants, and non-participants had for participating, or not participating, in a longitudinal cohort study on prediction and development of diabetes in children. STUDY DESIGN A questionnaire addressing each of these groups, where respondents graded the importance of a set of listed reasons for participating/not participating, was randomly distributed to 2500 families in the All Babies in Southeast Sweden (ABIS) study region with children born between 1997 and 1999. RESULTS Lack of trust was not a central factor to a great majority of respondents who decided not to participate in the ABIS study or who later decided to opt out. Practical matters, like blood sampling and lack of time, were important factors to many more. Yet, four fifths of those who still participate in the ABIS study stated trust in the researchers to be an important factor to their initial decision to participate. CONCLUSIONS Trust in researchers may be a necessary prerequisite in order for people to be willing to participate in research, but practical matters such as time that has to be spent or pain involved in collecting blood were more important factors than lack of trust in explaining opt out in relation to the ABIS study.
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Affiliation(s)
- Gert Helgesson
- Stockholm Centre for Healthcare Ethics, Department of LIME, Karolinska Institutet, Stockholm, Sweden.
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Rantala J, Platten U, Lindgren G, Nilsson B, Arver B, Lindblom A, Brandberg Y. Risk perception after genetic counseling in patients with increased risk of cancer. Hered Cancer Clin Pract 2009; 7:15. [PMID: 19698175 PMCID: PMC2744911 DOI: 10.1186/1897-4287-7-15] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 08/23/2009] [Indexed: 12/31/2022] Open
Abstract
Background Counselees are more aware of genetics and seek information, reassurance, screening and genetic testing. Risk counseling is a key component of genetic counseling process helping patients to achieve a realistic view for their own personal risk and therefore adapt to the medical, psychological and familial implications of disease and to encourage the patient to make informed choices [1,2]. The aim of this study was to conceptualize risk perception and anxiety about cancer in individuals attending to genetic counseling. Methods The questionnaire study measured risk perception and anxiety about cancer at three time points: before and one week after initial genetic counseling and one year after completed genetic investigations. Eligibility criteria were designed to include only index patients without a previous genetic consultation in the family. A total of 215 individuals were included. Data was collected during three years period. Results Before genetic counseling all of the unaffected participants subjectively estimated their risk as higher than their objective risk. Participants with a similar risk as the population overestimated their risk most. All risk groups estimated the risk for children's/siblings to be lower than their own. The benefits of preventive surveillance program were well understood among unaffected participants. The difference in subjective risk perception before and directly after genetic counseling was statistically significantly lower in all risk groups. Difference in risk perception for children as well as for population was also statistically significant. Experienced anxiety about developing cancer in the unaffected subjects was lower after genetic counseling compared to baseline in all groups. Anxiety about cancer had clear correlation to perceived risk of cancer before and one year after genetic investigations. The affected participants overestimated their children's risk as well as risk for anyone in population. Difference in risk perception for children/siblings as for the general population was significant between the first and second measurement time points. Anxiety about developing cancer again among affected participants continued to be high throughout this investigation. Conclusion The participant's accuracy in risk perception was poor, especially in low risk individuals before genetic counseling. There was a general trend towards more accurate estimation in all risk groups after genetic counseling. The importance of preventive programs was well understood. Cancer anxiety was prevalent and associated with risk perception, but decreased after genetic counseling. [1] National Society of Genetic Counselors (2005), Genetic Counseling as a Profession. Available at (accessed November 25th 2007) [2] Julian-Reynier C., Welkenhuysen M-, Hagoel L., Decruyenaere M., Hopwood P. (2003) Risk communication strategies: state of the art and effectiveness in the context of cancer genetic services. Eur J of Human Genetics 11, 725-736.
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Affiliation(s)
- Johanna Rantala
- Department of Clinical Genetics, Karolinska University Hospital, L5:03, S-17176 Stockholm, Sweden.
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Metcalfe A, Werrett J, Burgess L, Chapman C, Clifford C. Cancer genetic predisposition: information needs of patients irrespective of risk level. Fam Cancer 2009; 8:403-12. [PMID: 19517270 DOI: 10.1007/s10689-009-9256-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
Abstract
Increased insight into the information needs of people about cancer genetic predisposition could allow materials to be developed to improve decision-making for those at high risk, whilst those at lower risk could have their anxiety reduced without the need for referral to genetics services. This study aimed to identify information needs of patients concerned about a genetic predisposition to cancer, and explore how this varied according to risk perception, cancer worry, personal motivation and demographics. Stage 1 used semi-structured telephone interviews pre and post participants' genetic risk assessment. The findings informed stage two, a structured questionnaire survey of 1,112 patients, pre and post their genetic risk assessment. Participants were stratified by risk level and included those concerned about an inherited predisposition to breast, ovarian or colorectal cancer. About 512 (46%) responded with equal proportions of responders and non-responders across the risk categories. Findings indicated that irrespective of a person's actual or perceived level of risk, cancer worry, demographic background or personal motivation; priorities in the type of information required were similar. Greatest emphasis focused on information provision about how risk was assessed. Least important was acquiring an understanding about genes and inheritance patterns. Most participants reported difficulties accessing or finding information. Peoples' information needs are consistent irrespective of their risk level and therefore generalised information packages could be developed for anyone requesting cancer genetic risk assessment. Better information is likely to assist patients' understanding and ultimately increase concordance with recommended screening and preventative measures.
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Affiliation(s)
- Alison Metcalfe
- School of Health & Population Science, College of Medicine & Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Landsbergen KM, Prins JB, Brunner HG, Kraaimaat FW, Hoogerbrugge N. Genetic testing for Lynch syndrome in the first year of colorectal cancer: a review of the psychological impact. Fam Cancer 2009; 8:325-37. [PMID: 19330464 PMCID: PMC2771129 DOI: 10.1007/s10689-009-9239-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 03/14/2009] [Indexed: 01/15/2023]
Abstract
An increasing number of patients with colorectal cancer (CRC) receive genetic counselling within 1 year after diagnosis. Little is known whether specific subgroups are more vulnerable for genetic testing related distress. A literature review was conducted to identify the psychological impact of CRC in the first year, and the additional impact of genetic testing. The electronic databases of PubMed, PsychInfo, Embase and the Cochrane Library were searched to identify all reports published between January 1997 and October 2007 on the psychological impact of (1) CRC-diagnosis up to 1 year after treatment and of (2) genetic testing for Lynch syndrome in patients with CRC. Studies on the psychological impact of genetic testing in newly diagnosed patient with CRC were not available. Either CRC patients diagnosed several years ago were studied and the focus was also often on the psychological impact of genetic testing prior to DNA-test disclosure. They show that limitations in emotional and social functioning can persist up to 1 year after CRC treatment, especially in those with a stoma or diagnosed before age 60. Female patients and male patients diagnosed before age 50 appear to be more vulnerable to genetic test-related distress. It is well known that being treated for CRC has great impact on psychological functioning. Little is known about the psychological impact during the first year after diagnosis and very little is known about the additional psychological effect of genetic testing for hereditary cancer in this period. We found presumptive evidence that specific subgroups of patients with CRC are more vulnerable for genetic-testing-related distress.
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Affiliation(s)
- Karin M Landsbergen
- Department of Human Genetics, Raboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands.
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Smerecnik CMR, Mesters I, Verweij E, de Vries NK, de Vries H. A systematic review of the impact of genetic counseling on risk perception accuracy. J Genet Couns 2009; 18:217-28. [PMID: 19291376 PMCID: PMC7451018 DOI: 10.1007/s10897-008-9210-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/10/2008] [Indexed: 01/21/2023]
Abstract
This review presents an overview of the impact of genetic counseling on risk perception accuracy in papers published between January 2000 and February 2007. The results suggest that genetic counseling may have a positive impact on risk perception accuracy, though some studies observed no impact at all, or only for low-risk participants. Several implications for future research can be deduced. First, future researchers should link risk perception changes to objective risk estimates, define risk perception accuracy as the correct counseled risk estimate, and report both the proportion of individuals who correctly estimate their risk and the average overestimation of the risk. Second, as the descriptions of the counseling sessions were generally poor, future research should include more detailed description of these sessions and link their content to risk perception outcomes to allow interpretation of the results. Finally, the effect of genetic counseling should be examined for a wider variety of hereditary conditions. Genetic counselors should provide the necessary context in which counselees can understand risk information, use both verbal and numerical risk estimates to communicate personal risk information, and use visual aids when communicating numerical risk information.
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Affiliation(s)
- Chris M R Smerecnik
- School for Public Health and Primary Care (Caphri), Department of Health Education and Health Promotion, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands.
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Bjorvatn C, Eide GE, Hanestad BR, Hamang A, Havik OE. Intrusion and avoidance in subjects undergoing genetic investigation and counseling for hereditary cancer. Support Care Cancer 2009; 17:1371-81. [PMID: 19224252 DOI: 10.1007/s00520-009-0594-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 01/27/2009] [Indexed: 11/25/2022]
Abstract
GOALS OF WORK Genetic counseling for hereditary cancer is expected to involve a growing number of individuals in the near future since an increasing number of genetic tests are offered. This study was designed to identify psychosocial variables predicting distress after genetic investigation and genetic counseling (GC) in order to develop new counseling strategies. MATERIALS AND METHODS A prospective multi-site study was undertaken on 214 patients undergoing GC for hereditary cancer to explore the relationships between socio-demographic variables, medical variables, social support, self-efficacy, physical functioning, satisfaction with GC, the level of worry after GC, results of genetic testing, and the course and outcomes of distress. Distress was measured with the Impact of Event Scale, which includes subscales of intrusion and avoidance. Patients completed questionnaires mailed to them before and after GC. MAIN RESULTS The mean level of intrusion and avoidance was moderate, even though one quarter of participants reported a severe level of intrusion at baseline. Subjects with a low level of self-efficacy at baseline and high level of worry immediately after GC seemed to be vulnerable to both intrusion and avoidance. Lower level of intrusion was also associated with having a first-degree relative with cancer, while a lower avoidance level was associated with a higher level of education, having cancer, more social support, and higher satisfaction with GC. CONCLUSIONS In this study, subjects who had lower level of self-efficacy at baseline and a high level of worry immediately after GC seemed to be vulnerable to both intrusion and avoidance in this study.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, 5018 Bergen, Norway.
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The Additive Effect of Co-Occurring Anxiety and Depression on Health Status, Quality of Life and Coping Strategies in Help-Seeking Tinnitus Sufferers. Ear Hear 2008; 29:947-56. [DOI: 10.1097/aud.0b013e3181888f83] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bjorvatn C, Eide GE, Hanestad BR, Havik OE. Anxiety and depression among subjects attending genetic counseling for hereditary cancer. PATIENT EDUCATION AND COUNSELING 2008; 71:234-243. [PMID: 18295433 DOI: 10.1016/j.pec.2008.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 12/19/2007] [Accepted: 01/07/2008] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The main aims of the study were to investigate changes in anxiety and depression over time in subjects attending genetic counseling (GC) for hereditary cancer, and secondly, to identify psychological, social, and medical variables associated with the course and outcome of anxiety and depression. METHODS Of 275 eligible individuals, 221 consented to participate, 214 returned the baseline questionnaire, and were included in a prospective multi-center study. Questionnaires were mailed to the subjects before and after the GC. RESULTS The mean values for anxiety and depression were quite low at all assessments. Mixed linear analyzes revealed that both anxiety and depression declined over time. Higher age, GC-related self-efficacy, and social support were associated with lower levels of anxiety. More social support, satisfaction with GC, self-rated physical function, and GC-related self-efficacy were associated with lower levels of depression. The effects of social support on both anxiety and depression had a significant interaction with time. CONCLUSION The results support the buffer theory, which proposes that social support acts as a buffer, protecting people from the potentially pathogenic influence of stressful life events, such as GC. PRACTICE IMPLICATIONS Subjects with less social support and less GC-related self-efficacy seem to be more vulnerable to anxiety and depression and should be offered extra attention by counselors.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Timmermans LM, van Zuuren FJ, van der Maazen RWM, Leer JWH, Kraaimaat FW. Monitoring and blunting in palliative and curative radiotherapy consultations. Psychooncology 2008; 16:1111-20. [PMID: 17345558 DOI: 10.1002/pon.1177] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The present research paper investigates how cancer patients' monitoring and blunting coping styles are reflected in their communications during their initial radiotherapy consultations and in their evaluations of the consultation. Additionally, it is explored how a patient's disease status (curative versus palliative) influences the effects of his or her cognitive styles. METHODS The study included 116 oncology patients receiving treatment from eight radiation oncologists. For 56 patients treatment intent was palliative and for the remaining 60 curative. The patients' communicative behaviors were assessed using the Roter Interaction Analysis System (RIAS). Within three days the patients completed a monitoring and blunting inventory and after another six weeks they evaluated the treatment decision and treatment information by postal questionnaire. RESULTS Monitoring was positively and blunting negatively related to the patient's expression of questions, emotions and decision-making issues. After six weeks 'high monitors' as opposed to 'low monitors' reported having more doubts about the treatment decision and being less satisfied with the information received while 'high blunters' expressed fewer doubts and more satisfaction than 'low blunters' did. Significant associations were all attributable to the palliative treatment group. CONCLUSION Cancer patients' communicative behaviors vis-à-vis their oncologist hinge on their cognitive styles and an unfavorable disease status enhances the effects.
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Affiliation(s)
- Liesbeth M Timmermans
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands.
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Prucka SK, McIlvried DE, Korf BR. Cancer risk assessment and the genetic counseling process: using hereditary breast and ovarian cancer as an example. Med Princ Pract 2008; 17:173-89. [PMID: 18408385 DOI: 10.1159/000117790] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 12/25/2007] [Indexed: 01/07/2023] Open
Abstract
While only a small proportion of cancers can be attributed to a hereditary susceptibility, identifying high-risk individuals plays an essential role in medical management and has a significant impact on the patient as well as their immediate and extended family members. This paper aims at increasing the medical professionals' knowledge of the components of a genetic counseling session, with particular attention toward identifying at-risk individuals and understanding the complexities of the testing process. In addition, tools are provided to assist in identifying these individuals in clinical practice and streamlining the referral process to a cancer genetics center.
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Affiliation(s)
- Sandra K Prucka
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Ala., USA
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Wakefield CE, Homewood J, Mahmut M, Taylor A, Meiser B. Usefulness of the Threatening Medical Situations Inventory in individuals considering genetic testing for cancer risk. PATIENT EDUCATION AND COUNSELING 2007; 69:29-38. [PMID: 17706910 DOI: 10.1016/j.pec.2007.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/30/2007] [Accepted: 07/01/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the Threatening Medical Situations Inventory (TMSI) in a community sample (Study 1), and to examine its usefulness in individuals with a strong family history of cancer (Study 2). METHODS Study 1 participants (N=276) completed 2 online surveys, 14 days apart. Study 2 participants (N=311) completed 2 questionnaires, 6 months apart. RESULTS Both studies revealed the inventory was psychometrically sound, although some concerns were raised about the factor structure. High monitors in Study 1 reported desiring more health-related information and an active role in medical decision-making. High monitors in Study 2 had the greatest knowledge increase when they received a detailed decision aid, compared to a brief pamphlet. CONCLUSION The TMSI is appropriate for use in both community and clinical samples. High monitors in the general community are more likely to prefer receiving as much health-related information as possible and desire an active role in decision-making about their health. PRACTICE IMPLICATIONS Familial cancer clinic patients may benefit from tailoring the amount of information they receive to their coping style, such that patients who are vigilant information-seekers may benefit most from receiving more detailed information about genetic testing.
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Kasparian NA, Wakefield CE, Meiser B. Assessment of Psychosocial Outcomes in Genetic Counseling Research: An Overview of Available Measurement Scales. J Genet Couns 2007; 16:693-712. [PMID: 17694397 DOI: 10.1007/s10897-007-9111-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/18/2007] [Indexed: 11/24/2022]
Abstract
The aim of the present paper was to describe and evaluate many of the measurement scales currently used in genetic counseling outcomes research. A team of three researchers reviewed the available literature and selected a variety of validated instruments suitable for measurement of genetic counseling outcomes. There are numerous scales to assess each of the following outcomes among counselees: satisfaction with genetic counseling; knowledge; decision-making; psychological adjustment; coping; perceived personal control; perceptions of disease risk; and family communication about genetic risk. However, the strengths and limitations inherent to each instrument warrant careful consideration prior to implementation. In the genetic counseling context, scale selection should be undertaken with thought directed towards the characteristics of the research sample (e.g. levels of literacy, culture, medical condition), the practicalities of the research setting (e.g. available funding and resources, time restrictions, researcher expertise), the purpose of the research (i.e. the specific aspect of the genetic counseling experience to be studied), and the science underlying the scale (e.g. theoretical framework, psychometric properties).
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Affiliation(s)
- Nadine A Kasparian
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Level 3 Dickinson Building, 2031, Randwick, Australia.
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Metcalfe A, Werrett J, Burgess L, Clifford C. Psychosocial impact of the lack of information given at referral about familial risk for cancer. Psychooncology 2007; 16:458-65. [PMID: 16933207 DOI: 10.1002/pon.1081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We aimed to identify patient' information and communication needs irrespective of their risk level, when they are referred for genetic risk assessment and genetic counselling for a predisposition to cancer. Semi-structured telephone interviews were conducted with a purposive sample of individuals referred to a clinical genetics unit for a risk assessment of their genetic predisposition to either breast, ovarian or colorectal cancer and stratified by their level of risk. Triangulation was achieved by focus groups conducted with specialist genetic health professionals. Twenty-three participants were interviewed pre- and post-genetic counselling or risk assessment. A further 11 completed a single interview, five pre-assessment and six post-assessment. Three focus groups were conducted with the genetic health professionals. The results showed that many participants were unaware they had been referred for genetic counselling and as a consequence they felt this caused difficulties in coping with the genetic risk information received. Health professionals corroborated these findings of people's lack of awareness about their referral. This work raises important questions about the psychosocial consequences of inadequate information provision at the point of referral by clinicians in primary and hospital-based healthcare that are responsible for referring the majority of people to clinical genetics units.
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Affiliation(s)
- Alison Metcalfe
- School of Health Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Manna G, Foddai E, Di Maggio MG, Pace F, Colucci G, Gebbia N, Russo A. Emotional expression and coping style in female breast cancer. Ann Oncol 2007; 18 Suppl 6:vi77-80. [PMID: 17591839 DOI: 10.1093/annonc/mdm231] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study of the relationship of emotional status and tumor etiology has been investigated in order to elaborate a multifactorial model able to provide an answer integrating the different disciplines on cancer. The aim of this work is to investigate the knowledge on the alexithymia construct, exploring the presence of such trait in women affected by mammary carcinoma and analyzing the used coping strategies. The study has also examined personal thoughts related to event control (locus of control). METHOD The Toronto Alexithymia Scale, Coping Orientation to Problems Experienced, and Locus of Control questionnaires were administered to a group of 86 women aged 31-55 years (mean = 43.7; SD 6.57)-experimental group (N = 44): women with breast cancer diagnosed in the last 6 months; control group (N = 42): women without oncologic pathology, referred at the aforementioned institutions to undergo a breast check-up. RESULTS According to our hypothesis and literature data, a significant presence of alexithymic subjects (36.4% versus 2.4%; chi2 = 20.9; P < 0.0001) and a tendency to adopt coping strategies not focused on the problem were reported among women with mammary carcinoma. This causes incapability to act in order to actively contrast pathology-linked stress or to lower the effects. CONCLUSION Our results indicate that the tendency to repress one's emotions is associated to some general schemes of reaction to stress which, when used in a dysfunctional manner (such as the attempt to ignore how threatening an event is), are maladaptive in the end.
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Affiliation(s)
- G Manna
- Department of Psychology, Università di Palermo, Italy
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Bjorvatn C, Eide GE, Hanestad BR, Øyen N, Havik OE, Carlsson A, Berglund G. Risk perception, worry and satisfaction related to genetic counseling for hereditary cancer. J Genet Couns 2007; 16:211-22. [PMID: 17279329 DOI: 10.1007/s10897-006-9061-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients' worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients' and counselors' scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients' perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients' psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Charles S, Kessler L, Stopfer JE, Domchek S, Halbert CH. Satisfaction with genetic counseling for BRCA1 and BRCA2 mutations among African American women. PATIENT EDUCATION AND COUNSELING 2006; 63:196-204. [PMID: 16533589 DOI: 10.1016/j.pec.2005.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 10/14/2005] [Accepted: 10/23/2005] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate satisfaction with genetic counseling for BRCA1 and BRCA2 (BRCA1/2) mutations among African American women. METHODS Participants were 54 African American women at moderate and high risk for BRCA1/2 mutations who were offered genetic testing as part of a randomized clinical trial designed to compare the effects of culturally tailored genetic counseling (CTGC) and standard genetic counseling (SGC). Satisfaction with genetic counseling was evaluated using a self-administered questionnaire following culturally tailored or standard pre-test education and counseling. RESULTS Overall, the majority of women (96%) were very satisfied with genetic counseling; however, only 26% reported that their worries were lessened and 22% reported that they were able to cope better. Women who received CTGC were significantly more likely than women who received SGC to report that their worries were lessened (p<0.05). In addition, women with household incomes less than US$ 35,000 were significantly more likely to report that the counselor lessened their worries compared to women with higher incomes (p<0.05). CONCLUSIONS Most African American women were satisfied with genetic counseling; however, women who received culturally tailored genetic counseling were significantly more likely to strongly agree that their worries were lessened compared to women who received standard genetic counseling. PRACTICE IMPLICATIONS Discussion of cultural beliefs and values during genetic counseling may be beneficial to African American women, especially those with low incomes.
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Affiliation(s)
- Sarah Charles
- Genetic Counseling Training Program, Arcadia University, Glenside, PA, United States
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Phelps C, Bennett P, Iredale R, Anstey S, Gray J. The development of a distraction-based coping intervention for women waiting for genetic risk information: a phase 1 qualitative study. Psychooncology 2006; 15:169-73. [PMID: 15929031 DOI: 10.1002/pon.937] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study explored the emotional and coping responses of women referred for cancer genetic risk assessment and the acceptability of a written distraction-based coping intervention. Fifteen women recently referred into the Cancer Genetics Service for Wales (CGSW) took part in a focus group study. The women were divided into two groups, each of which met twice. During the first session, each group discussed their psychological responses to the referral and how they coped with their worries. Women discussed the potential role of the intervention in minimising distress. Analysis of the transcripts revealed that most women welcomed the referral to CGSW and that it did not create distress. However, there was concern for family members and anxiety about subsequent stages of the assessment process. The intervention was considered appropriate and potentially effective.
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Affiliation(s)
- Ceri Phelps
- Cancer Genetics Service for Wales, Institute of Medical Genetics, Cardiff University, UK.
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Consedine NS, Morgenstern AH, Kudadjie-Gyamfi E, Magai C, Neugut AI. Prostate cancer screening behavior in men from seven ethnic groups: the fear factor. Cancer Epidemiol Biomarkers Prev 2006; 15:228-37. [PMID: 16492909 DOI: 10.1158/1055-9965.epi-05-0019] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rates of prostate cancer screening are known to vary among the major ethnic groups. However, likely variations in screening behavior among ethnic subpopulations and the likely role of psychological characteristics remain understudied. We examined differences in prostate cancer screening among samples of 44 men from each of seven ethnic groups (N = 308; U.S.-born European Americans, U.S.-born African Americans, men from the English-speaking Caribbean, Haitians, Dominicans, Puerto Ricans, and Eastern Europeans) and the associations among trait fear, emotion regulatory characteristics, and screening. As expected, there were differences in the frequency of both digital rectal exam (DRE) and prostate-specific antigen (PSA) tests among the groups, even when demographic factors and access were controlled. Haitian men reported fewer DRE and PSA tests than either U.S.-born European American or Dominican men, and immigrant Eastern European men reported fewer tests than U.S.-born European Americans; consistent with prior research, U.S.-born African Americans differed from U.S.-born European Americans for DRE but not PSA frequency. Second, the addition of trait fear significantly improved model fit, as did the inclusion of a quadratic, inverted U, trait fear term, even where demographics, access, and ethnicity were controlled. Trait fear did not interact with ethnicity, suggesting its effect may operate equally across groups, and adding patterns of information processing and emotion regulation to the model did not improve model fit. Overall, our data suggest that fear is among the key psychological determinants of male screening behavior and would be usefully considered in models designed to increase male screening frequency.
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Affiliation(s)
- Nathan S Consedine
- Psychology Department, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA.
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Codori AM, Waldeck T, Petersen GM, Miglioretti D, Trimbath JD, Tillery MA. Genetic counseling outcomes: perceived risk and distress after counseling for hereditary colorectal cancer. J Genet Couns 2005; 14:119-32. [PMID: 15959643 DOI: 10.1007/s10897-005-4062-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Genetic counseling may turn risk information into cancer prevention behavior by modifying health beliefs and cancer-related distress. We assessed the effect of genetic counseling on these factors in 101 adult first-degree-relatives of colorectal cancer patients from families with known or suspected hereditary nonpolyposis colorectal cancer. Before counseling and once afterward, subjects completed self-report measures of perceived lifetime risk and cancer-distress. Most persons overestimated their cancer risk, and higher perceived risk was associated with believing that colorectal cancer cannot be prevented. Individual perceived risk changed after counseling, although mean perceived risk was unchanged. After adjusting for baseline risk, older persons and those with higher estimated objective cancer risk had larger postcounseling decreases. Distress after counseling was positively correlated with baseline distress and anxiety symptoms, and inversely correlated with tolerance for ambiguity. The findings suggest counseling interventions that should increase the likelihood of screening and offer hypotheses for future research.
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Affiliation(s)
- Ann-Marie Codori
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Meiser B, Collins V, Warren R, Gaff C, St John DJB, Young MA, Harrop K, Brown J, Halliday J. Psychological impact of genetic testing for hereditary non-polyposis colorectal cancer. Clin Genet 2005; 66:502-11. [PMID: 15521977 DOI: 10.1111/j.1399-0004.2004.00339.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The psychological impact of predictive genetic testing for hereditary non-polyposis colorectal cancer (HNPCC) was assessed in 114 individuals (32 carriers and 82 non-carriers) attending familial cancer clinics, using mailed self-administered questionnaires prior to, 2 weeks, 4 months and 12 months after carrier status disclosure. Compared to baseline, carriers showed a significant increase in mean scores for intrusive and avoidant thoughts about colorectal cancer 2 weeks (t = 2.49; p = 0.014) and a significant decrease in mean depression scores 2 weeks post-notification of result (t = -3.98; p < 0.001) and 4 months post-notification of result (t = -3.22; p = 0.002). For non-carriers, significant decreases in mean scores for intrusive and avoidant thoughts about colorectal cancer were observed at all follow-up assessment time points relative to baseline. Non-carriers also showed significant decreases from baseline in mean depression scores 2 weeks, 4 months and 12 months post-notification. Significant decreases from baseline for mean state anxiety scores were also observed for non-carriers 2 weeks post-notification (t = -3.99; p < 0.001). These data indicate that predictive genetic testing for HNPCC leads to psychological benefits amongst non-carriers, and no adverse psychological outcomes were observed amongst carriers.
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Affiliation(s)
- B Meiser
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Sydney, and School of Psychiatry, University of NSW, Sydney, Australia.
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