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Hanson EN, Delacroix E, Austin S, Carr G, Kidwell KM, Bacon E, Gerido LH, Griggs JJ, Stoffel EM, Resnicow K. Psychosocial factors impacting barriers and motivators to cancer genetic testing. Cancer Med 2023; 12:9945-9955. [PMID: 36808717 PMCID: PMC10166953 DOI: 10.1002/cam4.5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Only a small proportion of patients who qualify for clinical genetic testing for cancer susceptibility get testing. Many patient-level barriers contribute to low uptake. In this study, we examined self-reported patient barriers and motivators for cancer genetic testing. METHODS A survey comprised of both new and existing measures related to barriers and motivators to genetic testing was emailed to patients with a diagnosis of cancer at a large academic medical center. Patients who self-reported receiving a genetic test were included in these analyses (n = 376). Responses about emotions following testing as well as barriers and motivators prior to getting testing were examined. Group differences in barriers and motivators by patient demographic characteristics were examined. RESULTS Being assigned female at birth was associated with increased emotional, insurance, and family concerns as well as increased health benefits compared to patients assigned male at birth. Younger respondents had significantly higher emotional and family concerns compared to older respondents. Recently diagnosed respondents expressed fewer concerns about insurance implications and emotional concerns. Those with a BRCA-related cancer had higher scores on social and interpersonal concerns scale than those with other cancers. Participants with higher depression scores indicated increased emotional, social and interpersonal, and family concerns. CONCLUSIONS Self-reported depression emerged as the most consistent factor influencing report of barriers to genetic testing. By incorporating mental health resources into clinical practice, oncologists may better identify those patients who might need more assistance following through with a referral for genetic testing and the response afterwards.
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Affiliation(s)
- Erika N. Hanson
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Emerson Delacroix
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah Austin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Grant Carr
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Kelley M. Kidwell
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Elizabeth Bacon
- Center for Health Communications Research, Rogel Cancer Center, Michigan MedicineAnn ArborMichiganUSA
| | - Lynette Hammond Gerido
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/OncologyUniversity of MichiganAnn ArborMichiganUSA
- School of Public Health, Department of Health Management and PolicyUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Elena M. Stoffel
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Ken Resnicow
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
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Bourdon JL, Dorsey A, Zalik M, Pietka A, Salyer P, Bray MJ, Bierut LJ, Ramsey AT. In-vivo design feedback and perceived utility of a genetically-informed smoking risk tool among current smokers in the community. BMC Med Genomics 2021; 14:139. [PMID: 34039360 PMCID: PMC8152342 DOI: 10.1186/s12920-021-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The use of genetically-informed personalized risk information for behavioral disorders, namely smoking and smoking-related behaviors, is a promising yet understudied area. The Genetics and Smoking Risk Profile, or RiskProfile, leverages genetic and environmental information to communicate one’s risk for smoking-related diseases. Although prior studies have examined attitudes toward genetic results, little research has investigated these perceptions through a lens of in-vivo testing; that is, user-centered design feedback in response to personalized genetic results being returned contemporaneously. This qualitative study engaged current smokers in usability testing of the RiskProfile within the context of concurrently receiving this personalized, genetically-informed smoking cessation intervention. Methods Eighty-nine participants who were current smokers responded to open-ended interview questions on perceptions of smoking-related genetic information and the content and format of the RiskProfile intervention that they had received moments before. Data were analyzed via the conventional content analysis approach in which themes were allowed to emerge throughout the analysis. Results Participants were able to reference and offer design input on specific elements of the RiskProfile. Overall, current smokers perceived the RiskProfile to have high potential utility. Constructive feedback that current smokers offered about the tool centered around suggested improvements to optimize its usability and technical content. Conclusions The detailed and constructive feedback from participants highlights that in-vivo feedback offers a useful design approach that addresses concerns of rigor and relevance when returning genetic results. This unique method demonstrated perceived utility and constructive design feedback for the RiskProfile among current smokers and can play an important role in optimizing the design and implementation of personalized genetic risk interventions moving forward. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-00976-1.
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Affiliation(s)
- Jessica L Bourdon
- Wellbridge Center for Addiction Treatment and Research, Center for Addiction Science, 525 Jan Way, Room 1523, Calverton, NY, 11922, USA.
| | - Amelia Dorsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Maia Zalik
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Pietka
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Patricia Salyer
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael J Bray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alex T Ramsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
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LePoire E, Basu B, Walker L, Bowen DJ. What do people think about genetics? A systematic review. J Community Genet 2018; 10:171-187. [PMID: 30406598 DOI: 10.1007/s12687-018-0394-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022] Open
Abstract
Genetics is increasingly becoming a part of modern medical practice. How people think about genetics' use in medicine and their daily lives is therefore essential. Earlier studies indicated mixed attitudes about genetics. However, this might be changing. Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) as a guideline, we initially reviewed 442 articles that looked at awareness, attitudes, knowledge, and perception of risks among the general and targeted recruitment populations. After fitting our criteria (from the last 5 years, conducted in the USA, non-provider populations, quantitative results reported, and assessed participants 18 years and older), finally 51 eligible articles were thematically coded and presented in this paper. Awareness is reported as relatively high in the studies reviewed. Attitudes are mixed but with higher proportions reporting positive attitudes towards genetic testing and counseling. Self-reported knowledge is reasonably high, specifically with the effects of specific programs developed to raise knowledge levels of the general and targeted recruited populations. Perception of risk is somewhat aligned with actual risk. With the reasonable positive reports of genetic awareness and knowledge, there is similar positive attitude and perception of risk, supporting the need for continued dissemination of such knowledge. Given interest in incorporating community participation in genomic educational strategies, we provide this review as a baseline from which to launch community-specific educational supports and tools.
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Affiliation(s)
- Erin LePoire
- University of Washington, Box 357120, Seattle, WA, 98195, USA
| | - Baishakhi Basu
- University of Washington, Box 357120, Seattle, WA, 98195, USA
| | - Lorelei Walker
- Health Equity Circle, University of Washington, Seattle, WA, 98195, USA
| | - Deborah J Bowen
- University of Washington, Box 357120, Seattle, WA, 98195, USA.
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Fryer CS, Seaman EL, Clark RS, Plano Clark VL. Mixed methods research in tobacco control with youth and young adults: A methodological review of current strategies. PLoS One 2017; 12:e0183471. [PMID: 28841689 PMCID: PMC5571971 DOI: 10.1371/journal.pone.0183471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/07/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology. METHODS Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research. RESULTS We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs. CONCLUSIONS The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.
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Affiliation(s)
- Craig S. Fryer
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Elizabeth L. Seaman
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Rachael S. Clark
- Educational Studies, School of Education, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Vicki L. Plano Clark
- Educational Studies, School of Education, University of Cincinnati, Cincinnati, Ohio, United States of America
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Seo J, Ivanovich J, Goodman MS, Biesecker BB, Kaphingst KA. Information Topics of Greatest Interest for Return of Genome Sequencing Results among Women Diagnosed with Breast Cancer at a Young Age. J Genet Couns 2017; 26:511-521. [PMID: 27542972 PMCID: PMC5318287 DOI: 10.1007/s10897-016-0006-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
We investigated what information women diagnosed with breast cancer at a young age would want to learn when genome sequencing results are returned. We conducted 60 semi-structured interviews with women diagnosed with breast cancer at age 40 or younger. We examined what specific information participants would want to learn across result types and for each type of result, as well as how much information they would want. Genome sequencing was not offered to participants as part of the study. Two coders independently coded interview transcripts; analysis was conducted using NVivo10. Across result types, participants wanted to learn about health implications, risk and prevalence in quantitative terms, causes of variants, and causes of diseases. Participants wanted to learn actionable information for variants affecting risk of preventable or treatable disease, medication response, and carrier status. The amount of desired information differed for variants affecting risk of unpreventable or untreatable disease, with uncertain significance, and not health-related. Women diagnosed with breast cancer at a young age recognize the value of genome sequencing results in identifying potential causes and effective treatments and expressed interest in using the information to help relatives and to further understand their other health risks. Our findings can inform the development of effective feedback strategies for genome sequencing that meet patients' information needs and preferences.
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Affiliation(s)
- Joann Seo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Jennifer Ivanovich
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Dwyer LA, Shepperd JA, Stock ML. Predicting Avoidance of Skin Damage Feedback Among College Students. Ann Behav Med 2016; 49:685-95. [PMID: 25894276 DOI: 10.1007/s12160-015-9703-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Showing people a personal ultraviolet (UV) photograph depicting skin damage can be an effective method for changing sun protection cognitions and behaviors. PURPOSE We examined whether people opt not to see their UV photograph if given a choice. We also examined predictors of avoidance of skin damage feedback. METHODS College students (N = 257) completed questionnaires, viewed example UV photographs, and received the opportunity to see a UV photograph of their face. RESULTS Over one-third of participants opted not to see their UV photograph. Greater perceived risk of sun damage and having fewer coping resources corresponded with greater avoidance, particularly among participants who reported infrequent sun protection behavior. CONCLUSION The health benefits of UV photography are realized only if people are willing to view the photograph. Our findings suggest the need for interventions that increase receptivity to viewing one's UV photograph.
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Affiliation(s)
- Laura A Dwyer
- The George Washington University, Washington, DC, USA,
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Waters EA, Ball L, Carter K, Gehlert S. Smokers' beliefs about the tobacco control potential of "a gene for smoking": a focus group study. BMC Public Health 2014; 14:1218. [PMID: 25424390 PMCID: PMC4258807 DOI: 10.1186/1471-2458-14-1218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/03/2014] [Indexed: 12/25/2022] Open
Abstract
Background Several genetic variations associated with nicotine dependence and lung cancer exist. Translating this knowledge into tobacco control policy relies on smokers’ perceptions of the implications of the research. This study explored smokers’ beliefs about the tobacco control uses for research examining genomics, smoking, and addiction. Method Smokers (N = 85) participated in one of thirteen focus groups and one interview, stratified by race (eight black, six white) and education (seven < Bachelor’s degree, seven ≥ Bachelor’s degree). Data were analyzed by two independent coders using standard analysis and validation techniques. Results Nearly all groups suggested using genetic information for youth-oriented tobacco prevention education. Beliefs about the effectiveness of such actions varied. Many participants believed that providing smokers personalized genetic testing results or informing them about the existence of a gene would not motivate people to quit. All smokers emphasized the need for improved smoking cessation treatment options. Using genomics research to develop gene therapies and personalized drug treatments were also mentioned, yet perceptions of such treatments were mixed. Whereas some participants viewed the possibility positively, others expressed concern about cost and access. Participants who were skeptical of the effectiveness of using genetic information for tobacco control noted that the harms of tobacco use are widely known and genetic information does not add much of a deterrent. Conclusion Participants generated several possible tobacco control uses for genomics research findings. Our findings suggest that tobacco control experts should consult with smokers prior to implementing tobacco control measures. The potential public health benefits of genetics and genomics research related to tobacco use cannot be realized until communication strategies that are most likely to encourage and support tobacco avoidance decisions, and minimize mistrust and backlash, are identified.
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Affiliation(s)
- Erika A Waters
- Department of Surgery-Division of Public Health Sciences, Washington University in St, Louis, Saint Louis, MO, USA.
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Middlemass JB, Yazdani MF, Kai J, Standen PJ, Qureshi N. Introducing genetic testing for cardiovascular disease in primary care: a qualitative study. Br J Gen Pract 2014; 64:e282-9. [PMID: 24771842 PMCID: PMC4001138 DOI: 10.3399/bjgp14x679714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/02/2013] [Accepted: 02/09/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While primary care systematically offers conventional cardiovascular risk assessment, genetic tests for coronary heart disease (CHD) are increasingly commercially available to patients. It is unclear how individuals may respond to these new sources of risk information. AIM To explore how patients who have had a recent conventional cardiovascular risk assessment, perceive additional information from genetic testing for CHD. DESIGN AND SETTING Qualitative interview study in 12 practices in Nottinghamshire from both urban and rural settings. METHOD Interviews were conducted with 29 adults, who consented to genetic testing after having had a conventional cardiovascular risk assessment. RESULTS Individuals' principal motivation for genetic testing was their family history of CHD and a desire to convey the results to their children. After testing, however, there was limited recall of genetic test results and scepticism about the value of informing their children. Participants dealt with conflicting findings from the genetic test, family history, and conventional assessment by either focusing on genetic risk or environmental lifestyle factors. In some participants, genetic test results appeared to reinforce healthy behaviour but others were falsely reassured, despite having an 'above-average' conventional cardiovascular risk score. CONCLUSION Although genetic testing was acceptable, participants were unclear how to interpret genetic risk results. To facilitate healthy behaviour, health professionals should explore patients' understanding of genetic test results in light of their family history and conventional risk assessment.
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Affiliation(s)
- Jo B Middlemass
- School of Health and Social Care, University of Lincoln, Lincoln
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Sanderson SC, McBride CM, O'Neill SC, Docherty S, Shepperd J, Lipkus IM. Young smokers' interpretations of the estimated lung cancer risk associated with a common genetic variant of low penetrance. Public Health Genomics 2014; 17:68-75. [PMID: 24556984 DOI: 10.1159/000356708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/25/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- S C Sanderson
- Icahn School of Medicine at Mount Sinai, New York, N.Y., USA
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Hall MJ, Manne SL, Myers RE, Keenan EM, Balshem AM, Weinberg DS. Predictors of patient uptake of colorectal cancer gene environment risk assessment. Genome Med 2012. [PMID: 23194586 PMCID: PMC3580425 DOI: 10.1186/gm393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background In an ongoing clinical trial, the genetic and environmental risk assessment (GERA) blood test offers subjects information about personal colorectal cancer risk through measurement of two novel low-to-moderate risk factors. We sought to examine predictors of uptake of the GERA blood test among participants randomized to the Intervention arm. Methods Primary care patients aged 50 to 74 years eligible for colorectal cancer screening are randomized to receive a mailed stool blood test kit to complete at home (Control) or to the control condition plus an in-office blood test called GERA that includes assessment of red blood cell folate and DNA-testing for two MTHFR (methylenetetrahydrofolate reductase) single nucleotide polymorphisms (SNPs) (Intervention). For the present study, baseline survey data are examined in participants randomized to the Intervention. Results The first 351 intervention participants (161 African American/190 white) were identified. Overall, 249 (70.9%) completed GERA testing. Predictors of GERA uptake included race (African American race, odds ratio (OR) 0.51 (0.29 to 0.87)), and being more knowledgeable about GERA and colorectal cancer screening (OR 1.09 (1.01 to 1.18)). Being married (OR 1.81 (1.09 to 3.00)) was also significant in the multivariable model. Conclusions Participant uptake of GERA testing was high. GERA uptake varied, however, according to socio-demographic background and knowledge.
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Affiliation(s)
- Michael J Hall
- Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19038, USA
| | - Sharon L Manne
- Cancer Prevention and Control, Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA
| | - Ronald E Myers
- Department of Medical Oncology, Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Eileen M Keenan
- Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19038, USA
| | - Andrew M Balshem
- Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19038, USA
| | - David S Weinberg
- Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19038, USA
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