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Williams LS, Williams KM, Gillis N, Bolton K, Damm F, Deuitch NT, Farhadfar N, Gergis U, Keel SB, Michelis FV, Panch SR, Porter CC, Sucheston-Campbell L, Tamari R, Stefanski HE, Godley LA, Lai C. Donor-Derived Malignancy and Transplantation Morbidity: Risks of Patient and Donor Genetics in Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:255-267. [PMID: 37913908 PMCID: PMC10947964 DOI: 10.1016/j.jtct.2023.10.018] [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: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a key treatment option for hematologic malignancies (HMs), although it carries significant risks. Up to 30% of patients relapse after allo-HSCT, of which up to 2% to 5% are donor-derived malignancies (DDMs). DDMs can arise from a germline genetic predisposition allele or clonal hematopoiesis (CH) in the donor. Increasingly, genetic testing reveals that patient and donor genetic factors contribute to the development of DDM and other allo-HSCT complications. Deleterious germline variants in CEBPA, DDX41, GATA2, and RUNX1 predispose to inferior allo-HSCT outcomes. DDM has been linked to donor-acquired somatic CH variants in DNMT3A, ASXL1, JAK2, and IDH2, often with additional new variants. We do not yet have evidence to standardize donor genetic sequencing prior to allo-HSCT. The presence of hereditary HM disorders should be considered in patients with myeloid malignancies and their related donors, and screening of unrelated donors should include family and personal history of cytopenia and HMs. Excellent multidisciplinary care is critical to ensure efficient timelines for screening and necessary discussions among medical oncologists, genetic counselors, recipients, and potential donors. After allo-HSCT, HM relapse monitoring with genetic testing effectively results in genetic sequencing of the donor, as the transplanted hematopoietic system is donor-derived, which presents ethical challenges for disclosure to patients and donors. We encourage consideration of the recent National Marrow Donor Program policy that allows donors to opt-in for notification about detection of their genetic variants after allo-HSCT, with appropriate genetic counseling when feasible. We look forward to prospective investigation of the impact of germline and acquired somatic genetic variants on hematopoietic stem cell mobilization/engraftment, graft-versus-host disease, and DDM to facilitate improved outcomes through knowledge of genetic risk.
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Affiliation(s)
- Lacey S Williams
- Lombardi Clinical Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Kirsten M Williams
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Nancy Gillis
- Department of Cancer Epidemiology and Department of Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kelly Bolton
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Frederik Damm
- Hematology, Oncology, and Cancer Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie T Deuitch
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Usama Gergis
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siobán B Keel
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | | | - Sandhya R Panch
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Christopher C Porter
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Roni Tamari
- Memorial Sloan Kettering, New York, New York
| | - Heather E Stefanski
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Lucy A Godley
- Division of Hematology/Oncology and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Catherine Lai
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Taber JM, Peters E, Klein WMP, Cameron LD, Turbitt E, Biesecker BB. Motivations to learn genomic information are not exceptional: Lessons from behavioral science. Clin Genet 2023; 104:397-405. [PMID: 37491896 DOI: 10.1111/cge.14401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
Whether to undergo genome sequencing in a clinical or research context is generally a voluntary choice. Individuals are often motivated to learn genomic information even when clinical utility-the possibility that the test could inform medical recommendations or health outcomes-is low or absent. Motivations to seek one's genomic information can be cognitive, affective, social, or mixed (e.g., cognitive and affective) in nature. These motivations are based on the perceived value of the information, specifically, its clinical utility and personal utility. We suggest that motivations to learn genomic information are no different from motivations to learn other types of personal information, including one's health status and disease risk. Here, we review behavioral science relevant to motivations that may drive engagement with genome sequencing, both in the presence of varying degrees of clinical utility and in the absence of clinical utility. Specifically, we elucidate 10 motivations that are expected to underlie decisions to undergo genome sequencing. Recognizing these motivations to learn genomic information will guide future research and ultimately help clinicians to facilitate informed decision making among individuals as genome sequencing becomes increasingly available.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Ellen Peters
- Center for Science Communication Research and Psychology Department, University of Oregon, Eugene, Oregon, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Linda D Cameron
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Barbara B Biesecker
- Genomics, Bioinformatics and Translational Science, RTI International, Research Triangle Park, North Carolina, USA
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McBride CM, Roberts JS, Knerr S, Guan Y. Public Health Genomics: Time to Sharpen the Focus. Public Health Genomics 2023; 26:171-176. [PMID: 37729876 PMCID: PMC10614505 DOI: 10.1159/000533985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Colleen M. McBride
- Department of Behavioral, Social and Health Education Sciences, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - J. Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sarah Knerr
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory Rollins School of Public Health, Atlanta, GA, USA
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Wodoslawsky S, Fatunbi J, Mercier R, Braverman AM. Sperm donor attitudes and experiences with direct-to-consumer genetic testing. F S Rep 2023; 4:36-42. [PMID: 36959965 PMCID: PMC10028474 DOI: 10.1016/j.xfre.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 03/12/2023] Open
Abstract
Objective To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again. Design Cross-sectional online anonymous survey. Setting Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021. Patients Sperm donors from 1980 to 2020. Interventions None. Main outcome measures Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing. Results A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing. Conclusions Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.
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Affiliation(s)
- Sascha Wodoslawsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joy Fatunbi
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrea Mechanick Braverman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Reprint requests: Andrea Mechanick Braverman, Ph.D., Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 833 Chestnut Street, Mezzanine, Philadelphia, Pennsylvania 19004.
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Kalouguina V, Wagner J. On the determinants and the role of the payers in the uptake of genetic testing and data sharing in personalized health. Front Public Health 2023; 11:920286. [PMID: 36935717 PMCID: PMC10017738 DOI: 10.3389/fpubh.2023.920286] [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: 11/01/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background New health technologies and data offer tailored prevention and spot-on treatments, which can considerably reduce healthcare costs. In healthy individuals, insurers can participate in the creation of health capital through data and preventing the occurrence of a disease. In the onset of a disease, sequencing an individual's genome can provide information leading to the use of more efficient treatments. Both improvements are at the core of the "personalized health" paradigm. As a positive side effect, a reduction in healthcare costs is expected. However, the integration of personalized health in insurance schemes starts with a closer understanding of the demand drivers. Methods Using novel data from a survey carried out in Switzerland, we determine the factors influencing the uptake and sharing of data from genetic tests. In our regression analyses, we use five sets of socioeconomic, lifestyle, health insurance, sentiment, and political beliefs variables. Furthermore, two framings assess the willingness to undertake a test and the readiness to share results with an insurer when the costs of the test are borne by the insurer or the individual. Results We find that socioeconomic, lifestyle, or political belief variables have very little influence on the uptake of tests and the sharing of data. On the contrary, our results indicate that sentiment and insurance factors play a strong role. More precisely, if genetic tests are perceived as a mean to perform health prevention, this pushes individuals to take them. Furthermore, using the insurer's smartphone app leads to an increase of the likelihood to undergo a test and doubles the probability to share related data. Regarding insurance plans and deductible levels, there is no strong correlation neither with the willingness to take a test nor to share the data. Finally, individuals with complementary health insurance plans are less likely to share results. From the framings for the payment of genetic tests, our results indicate a positive effect of the insurer as a payer on the willingness to undertake tests as well as on data sharing. Conclusion Our results lay the ground for a deeper understanding of the role of payers on health decisions and sharing of health-related data. In particular, we find that it is relevant for health insurers to engage with their clients.
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Affiliation(s)
- Veronika Kalouguina
- Department of Actuarial Science, Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
- Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Joël Wagner
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Hollitt GL, Siggs OM, Ridge B, Keane MC, Mackey DA, MacGregor S, Hewitt AW, Craig JE, Souzeau E. Attitudes Toward Glaucoma Genetic Risk Assessment in Unaffected Individuals. Transl Vis Sci Technol 2022; 11:38. [DOI: 10.1167/tvst.11.10.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Georgina L. Hollitt
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Owen M. Siggs
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
- Garvan Institute of Medical Research Institute, Darlinghurst, Sydney, Australia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Miriam C. Keane
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - David A. Mackey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Lions Eye Institute, Centre for Ophthalmology and Vision Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alex W. Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jamie E. Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
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Naidoo L, Reddy P. Stakeholder knowledge and attitudes toward the use of predictive genetic testing in South Africa. J Community Genet 2022; 13:567-577. [PMID: 36085342 PMCID: PMC9462643 DOI: 10.1007/s12687-022-00606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
The use of predictive genetic testing, particularly for risk profiling in non-communicable diseases (NCDs), has the potential to benefit public health by decreasing the disease burden and alleviating the pressure on healthcare. It is thus important to assess knowledge and uptake among stakeholders. This study aimed to assess end users' (community, medical practitioners and medical students) knowledge and attitudes regarding the use and support of genomic medicine. A descriptive cross-sectional survey was conducted in Kwazulu-Natal (KZN) among 3 groups of stakeholders (n = 170): medical practitioners from both private and public healthcare, medical students from UKZN and community members represented by teachers. Three structured questionnaires using a Likert scale were administered. Responses were stratified by practice type, and a scoring scale was developed. Principal component analysis (PCA) was used to reduce data on all constructs that made up each variable. All three groups showed adequate knowledge and a positive attitude towards use, apart from medical students who were not as keen to support future use in their own practice. Although medical practitioners supported the use of this technology, with necessary guidelines, expertise and affordability, only 18% from private practice reported having used it. PCA reduced data to fewer parsimonious constructs for all 3 groups: common threads included an awareness that genetic testing may improve health and disease outcomes; guidelines for use; and the provision of education to increase awareness, training to bolster expertise and confidence to use these services. Participants in this study attributed a lack of uptake to limited expertise and professional support, and a lack of legislative guidelines. We recommend updating continuing professional development for medical practitioners and promoting community education concomitantly. Provision of guidelines and increased accessibility to resources are important.
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Affiliation(s)
- Levani Naidoo
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Poovendhree Reddy
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa.
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Mukherjee M, Eby M, Wang S, Lara-Millán A, Earle AM. Medicalizing risk: How experts and consumers manage uncertainty in genetic health testing. PLoS One 2022; 17:e0270430. [PMID: 35925961 PMCID: PMC9352100 DOI: 10.1371/journal.pone.0270430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
Given increased prevalence of direct-to-consumer (DTC) genetic health tests in recent years, this paper delves into discourses among researchers at professional genomics conferences and lay DTC genetic test users on popular discussion website Reddit to understand the contested value of genetic knowledge and its direct implications for health management. Harnessing ethnographic observations at five conferences and a text -analysis of 52 Reddit threads, we find both experts and lay patient-consumers navigate their own versions of “productive uncertainty.” Experts develop genetic technologies to legitimize unsettled genomics as medical knowledge and mobilize resources and products, while lay patient-consumers turn to Internet forums to gain clarity on knowledge gaps that help better manage their genetic risk states. By showing how the uncertain nature of genomics serves as a productive force placing both parties within a mutually cooperative cycle, we argue that experts and patient-consumers co-produce a form of relational medicalization that concretizes “risk” itself as a disease state.
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Affiliation(s)
- Meghna Mukherjee
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Margaret Eby
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Skyler Wang
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Armando Lara-Millán
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Althea Maya Earle
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
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Scarinci IC, Hansen B, Green BL, Sodeke SO, Price-Haywood EG, Kim YI. Willingness to participate in various nontherapeutic cancer research activities among urban and rural African American and Latinx healthy volunteers. Cancer Causes Control 2022; 33:1059-1069. [PMID: 35404020 DOI: 10.1007/s10552-022-01576-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Inclusion of racial/ethnic minorities in cancer research can reduce disparities in health outcomes; however, data regarding barriers and motivators to participation are sparse. This study assessed African American (AA) and Latinx healthy volunteers' perspectives regarding willingness to participate in noninvasive and invasive research activities. METHODS Using a 38-item questionnaire adapted from the Tuskegee Legacy Project Questionnaire, we assessed willingness to participate in 12 research activities, offering 27 possible barriers and 14 motivators. The sample was segmented into four subgroups by AA/Latinx and rural/urban. RESULTS Across five states and Puerto Rico, 533 participants completed questionnaires. Overall, participants were more willing to participate in noninvasive versus invasive procedures, although, all subgroups were willing to participate in research if asked. Rural AA were most willing to complete a survey or saliva sample, while rural Latinx were least willing. Urban AA were least willing to provide cheek swab, while rural counterparts were most willing. Self-benefit and benefit to others were among the top three motivators for all subgroups. Curiosity was a primary motivator for urban AA while obtaining health information motivated rural Latinx. Primary barriers included fears of side effects and being experimented on, lack of information, and lack of confidentiality. CONCLUSIONS Latinx and AAs are willing to participate in the continuum of nontherapeutic research activities suggesting their lack of participation may be related to not being asked. Inclusive enrollment may be achieved by assessing needs of participants during the design phase of a study in order to reduce barriers to participation.
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Affiliation(s)
- Isabel C Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA.
| | - Barbara Hansen
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA
| | | | | | | | - Young-Il Kim
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 10360F, Birmingham, Albama, 35249, USA
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Sylvia N, Joseph O, David KM, Ian M, Janet N, Nelson NF, John B, Betty K, Charles I, Adelline T, Nelson S, Erisa Sabakaki M. Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study. RESEARCH ETHICS 2022; 18:193-209. [PMID: 36213304 PMCID: PMC9536131 DOI: 10.1177/17470161221076974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.
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Affiliation(s)
| | | | | | | | | | | | - Barugahare John
- Makerere University College of Humanities and Social Sciences, Uganda
| | | | | | | | | | - Mwaka Erisa Sabakaki
- Makerere University College of Health Sciences, Uganda
- Infectious Diseases Institute, Uganda
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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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Napier CE, Davies G, Butow PN, Schlub TE, Best MC, Bartley N, Juraskova I, Meiser B, Tucker KM, Biesecker BB, Thomas DM, Ballinger ML. Cancer patient knowledge about and behavioral intentions after germline genome sequencing. PATIENT EDUCATION AND COUNSELING 2022; 105:707-718. [PMID: 34247865 DOI: 10.1016/j.pec.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/08/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Germline genome sequencing (GS) is becoming mainstream in cancer diagnosis and risk management. Identifying knowledge gaps and determinants of health behavior change intentions will enable effective targeting of educational and management strategies to translate genomic findings into improved cancer outcomes. METHODS Probands diagnosed with cancer of likely genetic origin that consented to but not yet undergone GS, and their biological relatives, completed a cross-sectional questionnaire assessing GS knowledge and hypothetical intention to change behaviors. RESULTS Probands (n = 348; 57% university educated) and relatives (n = 213; 38% university educated) had moderate GS knowledge levels, with greater knowledge associated with higher education. Both populations reported high behavioral change intentions, significantly associated with being female (p = 0.01) and greater perceived importance of GS (p < 0.001), and for probands: being from English-speaking households (p = 0.003), higher socio-economic status (p = 0.01) and greater self-efficacy (p = 0.02). CONCLUSIONS Increasing GS knowledge will enable realistic participant expectations surrounding germline GS. Actual behavior change should be monitored to determine whether increased cancer risk knowledge results in altered cancer-related behavior and ultimately, cancer outcomes. PRACTICE IMPLICATIONS Educational resources should target specific populations to ensure informed decision-making and expectation management. Support tools facilitating and maintaining behavioral change may be needed to achieve improved cancer patient outcomes.
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Affiliation(s)
- Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Grace Davies
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Phyllis N Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Timothy E Schlub
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
| | - Megan C Best
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
| | - Nicci Bartley
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Ilona Juraskova
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia
| | - Barbara B Biesecker
- Newborn Screening, Ethics and Disability Studies, RTI International, Washington, DC, USA
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
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Duenas DM, Shipman KJ, Porter KM, Shuster E, Guerra C, Reyes A, Kauffman TL, Hunter JE, Goddard KAB, Wilfond BS, Kraft SA. Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings. Genet Med 2022; 24:610-621. [PMID: 34906471 PMCID: PMC8939763 DOI: 10.1016/j.gim.2021.11.017] [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: 08/25/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. METHODS We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. RESULTS Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). CONCLUSION Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.
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Affiliation(s)
- Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.
| | - Kelly J Shipman
- Palliative Care and Resilience Research Program, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA
| | - Ana Reyes
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
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14
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Peck L, Borle K, Folkersen L, Austin J. Why do people seek out polygenic risk scores for complex disorders, and how do they understand and react to results? Eur J Hum Genet 2022; 30:81-87. [PMID: 34276054 PMCID: PMC8738734 DOI: 10.1038/s41431-021-00929-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023] Open
Abstract
We sought to explore individuals' motivations for using their direct-to-consumer genetic testing data to generate polygenic risk scores (PRSs) using a not-for-profit third-party tool, and to assess understanding of, and reaction to their results. Using a cross-sectional design, users of Impute.me who had already accessed PRS results were invited to complete an online questionnaire asking about demographics, motivations for seeking PRSs, understanding and interpretation of PRSs, and two validated scales regarding reactions to results-the Impact of Event Scale Revised (IES-R) and the Feelings About genomiC Testing Results (FACToR). Independent samples T-tests and ANOVA were used to explore associations between the variables. 227 individuals participated in the study. The most frequently reported motivation was general curiosity (98.2%). Only 25.6% of participants correctly answered all questions assessing understanding/interpretation of PRSs. Over half of participants (60.8%) experienced a negative reaction (upset, anxious, and/or sad on FACToR scale) after receiving their PRSs and 5.3% scored over the threshold for potential post-traumatic stress disorder on the IES-R. Lower understanding about PRS was associated with experiencing a negative psychological reaction (P values <0.001). Higher quality pre-test information, particularly to improve understanding, and manage expectations for PRS may be useful in limiting negative psychological reactions.
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Affiliation(s)
- Larissa Peck
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia Canada ,grid.412745.10000 0000 9132 1600London Health Sciences Centre, London, Ontario Canada
| | - Kennedy Borle
- grid.17091.3e0000 0001 2288 9830Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia Canada
| | - Lasse Folkersen
- Institute of Biological Psychiatry, Mental Health Centre Sankt Hans, Copenhagen, Denmark
| | - Jehannine Austin
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
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15
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Marwa B, Krueger J, Stephenson EA, Davidson S, Allan D, Knoppers B, Zawati M, Sullivan P, Shlien A, Malkin D, Fernandez CV, Villani A. Ethical and Analytic Challenges With Genomic Sequencing of Relapsed Hematologic Malignancies Following Allogeneic Hematopoietic Stem-Cell Transplantation. JCO Precis Oncol 2021; 5:1339-1347. [DOI: 10.1200/po.20.00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The implementation of precision medicine and next-generation sequencing technologies in the field of oncology is a novel approach being more widely studied and used in cases of high-risk primary and recurrent malignancies. Leukemias are the second most common cause of cancer-related mortality in children and the sixth most in adults. Relapsed leukemia represents a major component of the population that may benefit from genomic sequencing. However, ethical and analytic challenges arise when considering sequencing of biologic samples obtained from patients with relapsed leukemia following allogeneic hematopoietic stem-cell transplantation. Blood from the recipient after transplantation would include donor-derived cells and thus, genomic sequencing of recipient blood will interrogate the donor germline in addition to the somatic genetic profile of the leukemia cells and the recipient germline. This is a situation for which the donor will not have typically provided consent and may be particularly problematic if actionable secondary or incidental findings related to the donor are uncovered. We present the challenges raised in this scenario and provide strategies to mitigate this risk.
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Affiliation(s)
- Bilal Marwa
- Division of Pediatric Hematology and Oncology, IWK, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joerg Krueger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth A. Stephenson
- Division of Pediatric Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Scott Davidson
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Allan
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | | | - Adam Shlien
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Conrad V. Fernandez
- Division of Pediatric Hematology and Oncology, IWK, Dalhousie University, Halifax, Nova Scotia, Canada
- The Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anita Villani
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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16
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Apol KD, Lydersen LN, Mortensen Ó, Weihe P, Á Steig B, Andorsdóttir G, Gregersen NO. FarGen - participants in the genetic research infrastructure of the Faroe Islands. Scand J Public Health 2021; 50:980-987. [PMID: 34609256 PMCID: PMC9578100 DOI: 10.1177/14034948211046817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The demographic history of the Faroe Islands makes this isolated population – founded in the 9th century – interesting for genetic research. The goal of the FarGen project was to recruit individuals to the FarGen infrastructure to promote research into the genetic features of the Faroese people, and to develop a reference panel of population-specific variants. We aimed to recruit 1500 individuals. Participation was voluntary; participants had to donate a blood sample for whole-genome sequencing, and had to answer a questionnaire regarding sociodemographics, health, motivation and attitude towards participation in genetic research. Methods: A total of 1541 participants voluntarily joined the project, donated a blood sample and returned the questionnaire. Results: Answers from the questionnaire show that participants are, in general, European, have children, have a relatively high level of education, rate their health to be good, are willing to participate in future health-related research, and were motivated to sign up primarily to participate in research to help others and local research competency building. Conclusions: Overall, the initial cohort of the FarGen infrastructure comprises 3% of the Faroese population, and represents the general population well based on the collected sociodemographic data. However, there is an excess of women, and some geographic sub-regions and age groups are slightly underrepresented. We find the recruitment method with voluntary sign-up appropriate, and knowledge acquired through the first phase will aid the next phase of the project, with the aim of expanding the FarGen cohort with additional individuals, bio-specimens and body measurements in order to perform multifactorial analyses.
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Affiliation(s)
- Katrin D Apol
- FarGen, The Genetic Biobank of the Faroe Islands, Tórshavn, Faroe Islands
| | - Leivur N Lydersen
- FarGen, The Genetic Biobank of the Faroe Islands, Tórshavn, Faroe Islands
| | - Ólavur Mortensen
- FarGen, The Genetic Biobank of the Faroe Islands, Tórshavn, Faroe Islands
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, Tórshavn, Faroe Islands
| | - Bjarni Á Steig
- General Medical Department, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Noomi O Gregersen
- FarGen, The Genetic Biobank of the Faroe Islands, Tórshavn, Faroe Islands
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Linderman MD, Suckiel SA, Thompson N, Weiss DJ, Roberts JS, Green RC. Development and Validation of a Comprehensive Genomics Knowledge Scale. Public Health Genomics 2021; 24:291-303. [PMID: 34058740 DOI: 10.1159/000515006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genomic testing is increasingly employed in clinical, research, educational, and commercial contexts. Genomic literacy is a prerequisite for the effective application of genomic testing, creating a corresponding need for validated tools to assess genomics knowledge. We sought to develop a reliable measure of genomics knowledge that incorporates modern genomic technologies and is informative for individuals with diverse backgrounds, including those with clinical/life sciences training. METHODS We developed the GKnowM Genomics Knowledge Scale to assess the knowledge needed to make an informed decision for genomic testing, appropriately apply genomic technologies and participate in civic decision-making. We administered the 30-item draft measure to a calibration cohort (n = 1,234) and subsequent participants to create a combined validation cohort (n = 2,405). We performed a multistage psychometric calibration and validation using classical test theory and item response theory (IRT) and conducted a post-hoc simulation study to evaluate the suitability of a computerized adaptive testing (CAT) implementation. RESULTS Based on exploratory factor analysis, we removed 4 of the 30 draft items. The resulting 26-item GKnowM measure has a single dominant factor. The scale internal consistency is α = 0.85, and the IRT 3-PL model demonstrated good overall and item fit. Validity is demonstrated with significant correlation (r = 0.61) with an existing genomics knowledge measure and significantly higher scores for individuals with adequate health literacy and healthcare providers (HCPs), including HCPs who work with genomic testing. The item bank is well suited to CAT, achieving high accuracy (r = 0.97 with the full measure) while administering a mean of 13.5 items. CONCLUSION GKnowM is an updated, broadly relevant, rigorously validated 26-item measure for assessing genomics knowledge that we anticipate will be useful for assessing population genomic literacy and evaluating the effectiveness of genomics educational interventions.
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Affiliation(s)
- Michael D Linderman
- Department of Computer Science, Middlebury College, Middlebury, Vermont, USA
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - David J Weiss
- Assessment Systems Corporation, Minneapolis, Minnesota, USA.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
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18
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Szakály Z, Kovács B, Szakály M, T. Nagy-Pető D, Popovics P, Kiss M. Consumer acceptance of genetic-based personalized nutrition in Hungary. GENES & NUTRITION 2021; 16:3. [PMID: 33648454 PMCID: PMC7923598 DOI: 10.1186/s12263-021-00683-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/06/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite the increasing number of personalized nutrition services available on the market, nutrigenomics-based level of personalization is still the exception rather than a mainstream activity. This can be partly explained by various factors of consumer acceptance of the new technology. While consumer attitudes toward genetic tests aiming to reveal the risks of a predisposition to various illnesses have already been examined by several research studies worldwide; consumer acceptance of nutrigenomics-based personalized nutrition has only been examined by a significantly lower number of papers, especially in the Central and Eastern European region. OBJECTIVE The purpose of this paper is to examine consumer acceptance of genetic-based personalized nutrition in Hungary. Therefore a national representative survey was conducted involving 1000 individuals. The starting point of the model used is the assumption that the consumer acceptance of personalized nutrition is influenced by its consumer perceptions, which are affected by psychological processes that, in a more general sense, determine acceptance of food innovations. RESULTS The results show that 23.5% of respondents accept genetic test-based personalized nutrition. Women were found to reject the new technology in a significantly smaller proportion than men. The relationship between other demographic variables (i.e. age groups, education and subjective income level) and the perception of genetic-based personalized nutrition is also significant. Our results indicate that it is perceived cost/benefit that is most strongly related to genetically based personalized dietary preferences, followed by perceived risk and subjective norms. Perceived uncertainty and perceived behavioural control, however, have only a weak relationship with genetic-based personalized dietary preferences. CONCLUSIONS Compared with the magnitude of the effect of socio-demographic criteria, it can be concluded that, on the whole, psychological processes in the individual have a greater influence on the development of preferences for genetic-based personalized nutrition than any socio-demographic factor. This also confirms the trend that there are more and more value-added products or value propositions (where a significant part of the value added is to be found in product innovation), for which psychological characteristics are/should be given more emphasis among the segmentation criteria.
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Affiliation(s)
- Zoltán Szakály
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
| | - Bence Kovács
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
| | - Márk Szakály
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
| | - Dorka T. Nagy-Pető
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
| | - Péter Popovics
- Institute of Applied Economics Sciences, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
| | - Marietta Kiss
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Debrecen, 4032 Hungary
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19
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Dufva YE, Westman H, Khilbom U, Sullivan PF, Johansson V. Swedish large-scale schizophrenia study: Why do patients and healthy controls participate? Schizophr Res 2021; 228:360-366. [PMID: 33548836 PMCID: PMC8358980 DOI: 10.1016/j.schres.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/07/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Insights into determination of study participation are useful for researchers, clinicians and for ethical considerations. Few large-scale genomic studies have involved motives for enrollment, in schizophrenia patients and unaffected controls. In a case-control study with participants recruited nation-wide in Sweden between 2005 and 2010, semi-structured interviews on motives and attitudes towards future studies were explored in 2767 schizophrenia cases and 4466 controls. In qualitative and quantitative analyses, we identified altruism as a major determinant in 84% of the cases and in 97% of the controls. Among pre-defined subcategories of altruism, cases with schizophrenia were more often referring to science for example, 'I want to help science move forward' or 'I want better medications for future generations' in relation to unaffected controls that were more often referring to common humanity such as 'It is my duty and responsibility to help'. In schizophrenia, motives related to personal benefit and social influence were reported by 9% and 5%. We conclude that individuals with schizophrenia frequently report altruistic motives for study participation, almost to the same extent as unaffected controls. In contrast to unfortunate stereotypes, people with schizophrenia wish others to benefit from their experiences with severe mental illness and should not be refrained from participating in genomic research.
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Affiliation(s)
- Ylva Eriksson Dufva
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Henrietta Westman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Ulrik Khilbom
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, Sweden
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Viktoria Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
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20
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Benedetti DJ, Marron JM. Ethical Challenges in Pediatric Oncology Care and Clinical Trials. Recent Results Cancer Res 2021; 218:149-173. [PMID: 34019168 DOI: 10.1007/978-3-030-63749-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The care of pediatric cancer patients is a vast departure from cancer care of adults. While the available treatment modalities-chemotherapy, radiation, and surgery-are the same, the diseases, care-delivery, and outcomes differ greatly. And just as 'children are not just little adults,' pediatric bioethics occupies a distinct place within the broader field of bioethics. In this chapter, we will begin with an introduction to fundamental principles and frameworks for understanding ethical issues in pediatrics, highlighting the triadic nature of medical decision-making between a physician, the child-patient, and the child's parent as the surrogate decision-maker. We will then delve into further details of how these principles and frameworks shape the care of children with cancer, examining specific ethical challenges commonly encountered by pediatric oncologists. We will traverse this landscape by examining issues involving (a) informed consent; (b) research involving children; (c) end of life; (d) genetic and genomic testing; and (e) professionalism. We also examine ethical challenges in clinical research, in children and more broadly. While not an exhaustive exploration of the myriad ethical issues one might encounter in pediatric cancer medicine and clinical trials, this chapter provides readers with a foundation for further reading.
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Affiliation(s)
- Daniel J Benedetti
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 2220 Pierce Avenue 397 PRB, Nashville, TN, 37232-6310, USA.
| | - Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Harvard Medical School, Center for Bioethics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, 02215, USA
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21
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Wagner KE, McCormick JB, Barns S, Carney M, Middleton FA, Hicks SD. Parent Perspectives Towards Genetic and Epigenetic Testing for Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:3114-3125. [PMID: 30903561 PMCID: PMC6755071 DOI: 10.1007/s10803-019-03990-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Examining community views on genetic/epigenetic research allows collaborative technology development. Parent perspectives toward genetic/epigenetic testing for autism spectrum disorder (ASD) are not well-studied. Parents of children with ASD (n = 131), non-ASD developmental delay (n = 39), and typical development (n = 74) completed surveys assessing genetic/epigenetic knowledge, genetic/epigenetic concerns, motives for research participation, and attitudes/preferences toward ASD testing. Most parents (96%) were interested in saliva-based molecular testing for ASD. Some had concerns about privacy (14%) and insurance-status (10%). None (0%) doubted scientific evidence behind genetic/epigenetic testing. Most reported familiarity with genetics (88%), but few understood differences from epigenetics (19%). Child developmental status impacted insurance concerns (p = 0.01). There is broad parent interest in a genetic/epigenetic test for ASD. It will be crucial to carefully consider and address bioethical issues surrounding this sensitive topic while developing such technology.
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Affiliation(s)
- Kayla E Wagner
- Quadrant Biosciences Inc., Syracuse, USA.,Departments of Neuroscience & Physiology, Psychiatry, Biochemistry & Molecular Biology, Pediatrics, State University of New York Upstate Medical University, Syracuse, USA
| | - Jennifer B McCormick
- Department of Humanities, Penn State College of Medicine, 500 University Drive Mail Code H134, Hershey, USA
| | - Sarah Barns
- Quadrant Biosciences Inc., Syracuse, USA.,Departments of Neuroscience & Physiology, Psychiatry, Biochemistry & Molecular Biology, Pediatrics, State University of New York Upstate Medical University, Syracuse, USA
| | - Molly Carney
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, Mail Code HS83, Hershey, USA
| | - Frank A Middleton
- Departments of Neuroscience & Physiology, Psychiatry, Biochemistry & Molecular Biology, Pediatrics, State University of New York Upstate Medical University, Syracuse, USA
| | - Steven D Hicks
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, Mail Code HS83, Hershey, USA.
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22
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Davies E, Craufurd D, MacLeod R. "It's being part of the big picture, even though you're a tiny jigsaw piece"-motivations and expectations of individuals participating in the Enroll-HD observational study. J Community Genet 2020; 11:421-432. [PMID: 32157658 PMCID: PMC7475145 DOI: 10.1007/s12687-020-00459-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
Predictive test guidelines for Huntington's disease (HD) recommend individuals are offered opportunities to participate in research regardless of test outcome. Consistent with most HD centres of excellence, the Manchester Centre for Genomic Medicine (MCGM) invites eligible individuals to participate in the observational study, Enroll-HD. Limited research has been conducted to date on the views of research participants and the possible impact of participation. The aim of this qualitative study was to explore the experiences of ten individuals taking part in the Enroll-HD study following pre-symptomatic testing for HD. Half of the individuals had tested positive for the HD mutation and the other half had tested negative. Participants were generally motivated to take part in the study by both personal and altruistic reasons. Overall, they were very positive about participation in Enroll-HD. Valuable aspects included good relationships with the research/clinical team, increased understanding of the condition, an enhanced self-image and a shared experience with affected parents. Issues for improvement to encourage participation included access to study site and more regular communication about study progress. Participants, while generally optimistic about research progress, were realistic about challenges.
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Affiliation(s)
- E Davies
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.
- Department of Clinical Genetics, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
| | - D Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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23
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Hammond J, Klapwijk JE, Hill M, Lou S, Ormond KE, Diderich KEM, Riedijk S, Lewis C. Parental experiences of uncertainty following an abnormal fetal anomaly scan: Insights using Han's taxonomy of uncertainty. J Genet Couns 2020; 30:198-210. [PMID: 32638447 PMCID: PMC8432163 DOI: 10.1002/jgc4.1311] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
For a number of prospective parents, uncertainty during pregnancy starts when an anomaly is found during a routine fetal anomaly scan. This may be followed by numerous tests to determine the etiology and nature of the anomaly. In this study, we aimed to understand how prospective parents perceive and manage uncertainty after being confronted with a structural anomaly during their routine ultrasound. Han's taxonomy of uncertainty was used as a framework to identify and understand the different types of uncertainty experienced. Interviews were held in the UK (n = 8 women and n = 1 male partner) and in the Netherlands (n = 7 women) with participants who had experienced uncertainty in their pregnancy after a fetal scan. Data were analyzed using thematic analysis, and the uncertainties experienced by parents were mapped against the dimensions of the Han taxonomy (sources, issues, and locus). Participants' experience of uncertainty was relevant to all dimensions and subcategories of the Han taxonomy, showing its applicability in the prenatal setting. Sources of uncertainty included receiving probabilistic or ambiguous information about the anomaly, or information that was complex and challenging to understand. Issues of uncertainty included were those that were scientific—such as a probable diagnosis with no further information, personal—such as the emotional impact of uncertainty, and practical—such as limited information about medical procedures and practical aspects of care. Additionally, participants described what helped them to manage uncertainty. This included active coping strategies such as searching for information on the Internet, external coping resources such as seeking social support, and internal coping resources such as using positivity and hope. Several recommendations for the healthcare professional to minimize uncertainty and help the patient deal with uncertainty have been proposed based on these findings.
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Affiliation(s)
- Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly E Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
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East KM, Cochran M, Kelley WV, Greve V, Emmerson K, Raines G, Cochran JN, Hott AM, Bick D. Understanding the present and preparing for the future: Exploring the needs of diagnostic and elective genomic medicine patients. J Genet Couns 2020; 28:438-448. [PMID: 30964585 DOI: 10.1002/jgc4.1114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Advances in genomic knowledge and technology have increased the use of comprehensive clinical sequencing tests. Genome sequencing has established utility for diagnosing patients with rare, undiagnosed diseases as well as interest in an elective context, without a clinical indication for testing. The Smith Family Clinic for Genomic Medicine, LLC in Huntsville, AL is a private practice genomic medicine clinic caring for both diagnostic (79%) and elective (21%) patients. Diagnostic and elective patients are seen on a clinical basis and receive standard care. Genome sequencing is provided on a self-pay basis, with assistance available for diagnostic patients who have financial need. Here, we describe demographics and motivations of the distinct patient populations and our experiences engaging patients in online education. Diagnostic patients were motivated by the possibility of receiving an explanation for symptoms (96%) while elective patients were motivated by the chance to learn about future disease risk (57%). Elective patients were less likely to engage with online education, with only 28% reading all assigned topics compared to 54% of diagnostic patients. Understanding the needs, interests, and barriers unique to diagnostic and elective patients is critical to inform individualized and scalable best practices in patient education and engagement.
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Affiliation(s)
- Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Meagan Cochran
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Veronica Greve
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Grace Raines
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Adam M Hott
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - David Bick
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
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Putt S, Yanes T, Meiser B, Kaur R, Fullerton JM, Barlow-Stewart K, Schofield PR, Toma C, Peay H, Mitchell PB. Exploration of experiences with and understanding of polygenic risk scores for bipolar disorder. J Affect Disord 2020; 265:342-350. [PMID: 32090758 DOI: 10.1016/j.jad.2020.01.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/27/2019] [Accepted: 01/11/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polygenic risk scores (PRSs) summarise genetic risk in complex genetic disorders such as bipolar disorder (BD). The aim of this study was to gain in-depth, nuanced information regarding the understanding and experience of receiving a PRS for BD from individuals who already have a BD diagnosis. METHODS Participants from a previous genetics study were invited to receive their PRS in a face-to-face consultation with a genetic counsellor or psychiatrist. Four weeks later, semi-structured interviews were conducted, with 14 'acceptors' (those who chose to receive their PRS) and 4 'decliners' (those who did not wish to receive their PRS). RESULTS Four themes were developed: (1) An easy decision, (2) A positive experience, (3) The grey area, and (4) The future is exciting and frightening. Despite some reported initial shock and distress, all acceptors described the experience of receiving their PRS as a positive one. It allowed them to better understand their condition and/or reduced feelings of self-blame. Decliners chose not to receive their results because of a lack of perceived usefulness or concern that PRS may hinder personal recovery. LIMITATIONS Given the qualitative design of the study, statistically valid generalisations cannot be undertaken, nor can causal relationships be established. CONCLUSIONS PRS for BD were generally well accepted and understood. Knowledge regarding the impact of PRS for BD ensures that counselling frameworks are responsive to patient needs as well as informing education for psychiatrists and genetic counsellors, who will play pivotal roles in future polygenic testing provision.
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Affiliation(s)
- Sophie Putt
- University of New South Wales Medicine, Sydney, NSW 2052, Australia.
| | - Tatiane Yanes
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rajneesh Kaur
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, Sydney, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2000, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, Sydney, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Claudio Toma
- Neuroscience Research Australia, Randwick, Sydney, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Holly Peay
- National Human Genome Research Institute, Bethesda, United States
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Black Dog Institute, Prince of Wales Hospital, Sydney, NSW 2052, Australia
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Development and mixed-methods evaluation of an online animation for young people about genome sequencing. Eur J Hum Genet 2020; 28:896-906. [PMID: 31896776 PMCID: PMC7316978 DOI: 10.1038/s41431-019-0564-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/08/2022] Open
Abstract
Children and young people with rare and inherited diseases will be significant beneficiaries of genome sequencing. However, most educational resources are developed for adults. To address this gap in informational resources, we have co-designed, developed and evaluated an educational resource about genome sequencing for young people. The first animation explains what a genome is, genomic variation and genome sequencing ("My Genome Sequence": http://bit.ly/mygenomesequence), the second focuses on the limitations and uncertainties of genome sequencing ("My Genome Sequence part 2": http://bit.ly/mygenomesequence2). In total, 554 school pupils (11-15 years) took part in the quantitative evaluation. Mean objective knowledge increased from before to after watching one or both animations (4.24 vs 7.60 respectively; t = 32.16, p < 0.001). Self-rated awareness and understanding of the words 'genome' and 'genome sequencing' increased significantly after watching the animation. Most pupils felt they understood the benefits of sequencing after watching one (75.4%) or both animations (76.6%). Only 17.3% felt they understood the limitations and uncertainties after watching the first, however this was higher among those watching both (58.5%, p < 0.001). Twelve young people, 14 parents and 3 health professionals consenting in the 100,000 Genomes Project reported that the animation was clear and engaging, eased concerns about the process and empowered young people to take an active role in decision-making. To increase accessibility, subtitles in other languages could be added, and the script could be made available in a leaflet format for those that do not have internet access. Future research could focus on formally evaluating the animations in a clinical setting.
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Physician Experience with Direct-To-Consumer Genetic Testing in Kaiser Permanente. J Pers Med 2019; 9:jpm9040047. [PMID: 31683813 PMCID: PMC6963876 DOI: 10.3390/jpm9040047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 02/08/2023] Open
Abstract
Health systems and physicians nationwide aspire to consistently and reliably apply genetic and genomic information to guide disease prevention, management, and treatment. However, clinical information, including genetics/genomics data from within and outside of the care delivery system, is expanding rapidly. Between November 2017 and April 2018, we surveyed 1502 Permanente Medical Group primary care and specialist physicians to assess the degree to which direct-to-consumer genetic test results were being presented to physicians and identify genetics educational needs among physicians (response rate 15%). Adjusted logistic regression (according to respondent characteristics) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing responses within groups. Results showed 35% and 12% of respondents reported receiving at least one direct-to-consumer health risk genetic result (DTC-health risk) or direct-to-consumer pharmacogenomic test result (DTC-PGx), respectively, from a patient in the past year. Of those receiving at least one test result, 40% (DTC-health risk) and 39% (DTC-PGx) of physicians reported 1+ referral(s); 78% (DTC-health risk) and 42% (DTC-PGx) of referrals were to clinical genetics. In total, 85% of physicians would spend ≥2 h/year on genetics/genomics education.
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28
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Holden C, Bignell L, Mukhopadhyay S, Jones C. The public perception of the facilitators and barriers to implementing personalized medicine: a systematic review. Per Med 2019; 16:409-420. [PMID: 31591926 DOI: 10.2217/pme-2018-0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The integration of personalized medicine (PM) into mainstream healthcare will only be successful if the public understands and supports this change. The aim was to understand the public perception of the barriers and facilitators towards the use of PM. A systematic review of the literature was conducted within six databases from 2006 to 2018. Twenty-one studies with 9507 participants were included. The key themes were familiarity and willingness to use PM, perceived benefits and perceived risks of PM. The review shows that the public is generally enthusiastic about the introduction of PM, although this should be interpreted with cautious optimism due to participants having a limited familiarity of the underlying principles of PM. The study defines areas where progress can be made to enhance this understanding and addresses legitimate concerns.
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Affiliation(s)
- Ciara Holden
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton & Sussex Medical School, Brighton, BN2 5BE, UK
| | - Lauren Bignell
- Academic Department of General Practice, Queen Mary University of London, Mile End Rd, London, E1 4NS, UK
| | - Somnath Mukhopadhyay
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton & Sussex Medical School, Brighton, BN2 5BE, UK
| | - Christina Jones
- Academic and Research Department, School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
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Abstract
SIGNIFICANCE The American Academy of Ophthalmology currently recommends against routine genetic testing for complex diseases such as age-related macular degeneration (AMD). The results of this study demonstrate that patients are very interested in predictive genetic testing for AMD, find the information useful, and make behavioral changes as a result of the information. PURPOSE The goal of this project was to conduct a pilot AMD genomic medicine study. METHODS Eligible patients were aged 50 to 65 years with no personal history of AMD. DNA samples were genotyped for five single-nucleotide polymorphisms (SNPs) in the CFH gene, one SNP in the ARMS-2 gene, one SNP in the C3 gene, and one SNP in the mitochondrial ND2 gene. A risk score was calculated utilizing a model based on odds ratios, lifetime risk of advanced AMD and known population prevalence of genotype, haplotype, and smoking risk. The study optometrist provided the patient's risk score and counseling for personal protective behaviors. Telephone interviews were conducted 1 to 3 months after the counseling visit. RESULTS One hundred one subjects (85%) participated in the genetic testing; 78 (77.2%) were female. Follow-up interviews were conducted with 94 participants (93.1%). More than half (n = 48) of the participants said that they were motivated to participate in the study because they had a family member with AMD or another eye or genetic disorder. Despite low risk levels, many participants reported making changes as a result of the genetic testing. Twenty-seven people reported making specific changes, including wearing sunglasses and brimmed hat and taking vitamin supplements. Another 16 people said that they were already doing the recommended activities, including wearing glasses, quitting smoking, and/or taking vitamins. CONCLUSIONS Interest in genetic testing for future risk of AMD was high in this population and resulted in support to continue current health behaviors or incentive to improve behaviors related to eye health.
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Schaper M, Wöhlke S, Schicktanz S. "I would rather have it done by a doctor"-laypeople's perceptions of direct-to-consumer genetic testing (DTC GT) and its ethical implications. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:31-40. [PMID: 29705970 DOI: 10.1007/s11019-018-9837-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Direct-to-consumer genetic testing (DTC GT) has been available for several years now, with varying degrees of regulation across different countries. Despite a restrictive legal framework it is possible for consumers to order genetic tests from companies located in other countries. However, German laypeople's awareness and perceptions of DTC GT services is still unexplored. We conducted seven focus groups (participants n = 43) with German laypeople to explore their perceptions of and attitudes towards commercial genetic testing and its ethical implications. Participants were critical towards DTC GT. Criticism was directed at health-related, predictive testing, while lifestyle tests were accepted and even welcomed to some extent. Participants expressed strong reservations regarding commercial provision of genetic diagnostics and expressed a lack of trust in respective companies. They preferred non-commercial distribution within the public healthcare system. Participants also expressed high expectations of physicians' abilities to interpret information obtained via DTC GT companies and provide counseling. Legal restrictions on commercial distribution of genetic tests were opposed, with participants arguing that it should be available to consumers. DTC GT companies are not perceived as trustworthy when compared to the public healthcare system and its professional ethical standards and practices. Laypeople rated general consumer autonomy higher than their own concerns, thus recommending against strong legal regulation. We conclude that medicine's trustworthiness may be negatively affected if commercial provision is not visibly opposed by the medical professions, while DTC GT companies may gain in trustworthiness if they adapt to standards and practices upheld in medicine.
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Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
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Marron JM, Cronin AM, DuBois SG, Glade-Bender J, Kim A, Crompton BD, Meyer SC, Janeway KA, Mack JW. Duality of purpose: Participant and parent understanding of the purpose of genomic tumor profiling research among children and young adults with solid tumors. JCO Precis Oncol 2019; 3. [PMID: 31240271 DOI: 10.1200/po.18.00176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Increasing use of genomic tumor profiling may blur the line between research and clinical care. We aimed to describe research participants' perspectives on the purpose of genomic tumor profiling research in pediatric oncology. METHODS We surveyed 45 participants (response rate 85%) in a pilot study of genomic profiling in pediatric solid tumors at four academic cancer centers following return of sequencing results. We defined understanding according to a one-item ("basic") definition (recognizing that the primary purpose was not to improve the patient's treatment) and a four-item ("comprehensive") definition (primary purpose was not to improve patient's treatment; primary purpose was to improve treatment of future patients; there may not be direct medical benefit; most likely result of participation was not increased likelihood of cure). RESULTS Sixty-eight percent of respondents (30/44) demonstrated basic understanding of the study purpose; 55% (24/44) demonstrated comprehensive understanding. Understanding was more frequently seen in those with higher education and greater genetic knowledge according to basic (81% vs 50%, p=0.05; and 82% vs 46%, p=0.03, respectively) and comprehensive definitions (73% vs 28%, p=0.01; 71% vs 23%, p=0.01). Ninety-three percent of respondents who believed the primary purpose was to improve the patient's care simultaneously stated that the research also aimed to benefit future patients. CONCLUSIONS Most participants in pediatric tumor profiling research understand that the primary goal of this research is to improve care for future patients, but many express dual goals when participating in sequencing research. Some populations demonstrate increased rates of misunderstanding. Nuanced participant views suggest further work is needed to assess and improve participant understanding, particularly as tumor sequencing moves beyond research into clinical practice.
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Affiliation(s)
- Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Office of Ethics, Boston Children's Hospital, Boston, Massachusetts.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts
| | - Angel M Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Steven G DuBois
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Julia Glade-Bender
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - AeRang Kim
- Department of Pediatric Oncology, Children's National Medical Center, Washington, District of Columbia
| | - Brian D Crompton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Stephanie C Meyer
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Connors E, Selove R, Canedo J, Sanderson M, Hull P, Adams M, McDermott I, Barlow C, Johns-Porter D, McAfee C, Gilliam K, Miller O, Cox N, Fadden MK, King S, Tindle H. Improving Community Advisory Board Engagement in Precision Medicine Research to Reduce Health Disparities. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:80-94. [PMID: 32832256 PMCID: PMC7442965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Community Advisory Boards (CABs) are used in efforts to reduce health disparities; however, there is little documentation in the literature regarding their use in precision medicine research. In this case study, an academic-CAB partnership developed a questionnaire and patient educational materials for two precision smoking cessation interventions that involved use of genetic or genetically-informed information. The community-engaged research (CEnR) literature provided a framework for enhancing benefits to CAB members involved in developing research documents for use with a low-income, ethnically diverse population of smokers.The academic partners integrated three CEnR strategies: 1) in-meeting statements acknowledging their desire to learn from community partners, 2) in-meeting written feedback to and from community partners, and 3) a survey to obtain CAB member feedback post-meetings. Strategies 1 and 2 yielded modifications to pertinent study materials, as well as suggestions for improving meeting operations that were then adopted, as appropriate, by the academic partners. The survey indicated that CAB members valued the meeting procedure changes which appeared to have contributed to improvements in attendance and satisfaction with the meetings. Further operationalization of relevant partnership constructs and development of tools for measuring these aspects of community-academic partnerships is warranted to support community engagement in precision medicine research studies.
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Affiliation(s)
| | | | | | | | | | - Marilyn Adams
- Meharry-Vanderbilt-TSU Cancer Partnership (MVTCP) Community Advisory Board
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Allen CG, Gabriel J, Flynn M, Cunningham TN, Wang C. The impact of raw DNA availability and corresponding online interpretation services: A mixed-methods study. Transl Behav Med 2018; 8:105-112. [PMID: 29385579 DOI: 10.1093/tbm/ibx009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Consumer access to third-party services to interpret raw DNA has raised concerns about downstream healthcare implications. This mixed-methods study set out to examine the extent to which genetic counselors have been contacted by consumers of third-party services and describe counselors' experiences with these "consumer" patients. Counselor views on the quality of information provided to consumers were also examined. Eighty-five genetic counselors completed an online survey, of which 22 completed in-depth telephone interviews. Survey and interview data were analyzed and combined using triangulation techniques. Over half (53%) of the survey respondents indicated they had been contacted by a patient following the use of a third-party raw DNA interpretation service. Among counselors contacted, 72% saw at least one patient. Counselors reported challenges unique to this patient population including overemphasis by patients on the validity of the data and patient resistance to information provided by the counselor. Preparation time burden and counselor inexperience and discomfort counseling these patients were additional challenges. Counselors expressed concern about the quality of the raw data and the clarity and usefulness of interpretation reports. Genetic counselors' experiences with consumer's use of third-party DNA interpretation services provide insight on the opportunities and challenges with the availability of raw DNA directly to consumers. Efforts to better support both consumers and genetic service providers are needed to maximize the effective translation of genome-based knowledge for population health.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jazmine Gabriel
- Genetic Counseling Program, Boston University School of Medicine, Boston, MA, USA
| | - Maureen Flynn
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Tricia N Cunningham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Lewis KL, Heidlebaugh AR, Epps S, Han PKJ, Fishler KP, Klein WMP, Miller IM, Ng D, Hepler C, Biesecker BB, Biesecker LG. Knowledge, motivations, expectations, and traits of an African, African-American, and Afro-Caribbean sequencing cohort and comparisons to the original ClinSeq ® cohort. Genet Med 2018; 21:1355-1362. [PMID: 30382154 DOI: 10.1038/s41436-018-0341-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Racial minority populations are underrepresented in genomics research. This study enrolled African-descended individuals in a sequencing study and reported their characteristics. METHODS We purposively recruited 467 individuals self-identified as African, African American, or Afro-Caribbean to the ClinSeq® study and surveyed them about knowledge, motivations, expectations, and traits. Summary statistics were calculated and compared with data from the study's original cohort, which was primarily White and self-referred. RESULTS Recruitment took five years and 83% of enrollees completed the survey. Participants had modest knowledge about benefits and limitations of sequencing (x̅s = 5.1, ranges: 0-10), and less than the original cohort (x̅ = 7.5 and 7.7, respectively). Common motivations to enroll were learning information relevant to personal health (49%) or family members' health (33%), and most had realistic expectations of sequencing. Like the original cohort, they had high levels of optimism, openness, and resilience. CONCLUSION Early adopters may have relatively consistent personality traits irrespective of majority/minority status and recruitment methods, but high levels of genomics knowledge are not universal. Research should determine whether recruitment and consent procedures provide adequate education to promote informed choices and realistic expectations, which are vital to ethical research and increasing genomics research participation in underrepresented communities.
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Affiliation(s)
- Katie L Lewis
- National Human Genome Research Institute, Bethesda, MD, USA.
| | | | - Sandra Epps
- National Human Genome Research Institute, Bethesda, MD, USA
| | - Paul K J Han
- Maine Medical Center Research Institute, Portland, Portland, ME, USA
| | | | - William M P Klein
- National Human Genome Research Institute, Bethesda, MD, USA.,National Cancer Institute, Bethesda, MD, USA
| | - Ilana M Miller
- National Human Genome Research Institute, Bethesda, MD, USA
| | - David Ng
- National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Barbara B Biesecker
- National Human Genome Research Institute, Bethesda, MD, USA.,Research Triangle Institute, Washington, DC, USA
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Scherr CL, Aufox S, Ross AA, Ramesh S, Wicklund CA, Smith M. What People Want to Know About Their Genes: A Critical Review of the Literature on Large-Scale Genome Sequencing Studies. Healthcare (Basel) 2018; 6:healthcare6030096. [PMID: 30096823 PMCID: PMC6165341 DOI: 10.3390/healthcare6030096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
From a public health perspective, the “All of Us” study provides an opportunity to isolate targeted and cost-effective prevention and early-detection strategies. Identifying motivations for participation in large-scale genomic sequencing (LSGS) studies, and motivations and preferences to receive results will help determine effective strategies for “All of Us” study implementation. This paper offers a critical review of the literature regarding LSGS for adult onset hereditary conditions where results could indicate an increased risk to develop disease. The purpose of this review is to synthesize studies which explored peoples’ motivations for participating in LSGS studies, and their desire to receive different types of genetic results. Participants were primarily motivated by altruism, desire to know more about their health, and curiosity. When asked about hypothetically receiving results, most participants in hypothetical studies wanted all results except those which were uncertain (i.e., a variant of uncertain significance (VUS)). However, participants in studies where results were returned preferred to receive only results for which an intervention was available, but also wanted VUS. Concerns about peoples’ understanding of results and possible psychosocial implications are noted. Most studies examined populations classified as “early adopters,” therefore, additional research on motivations and expectations among the general public, minority, and underserved populations is needed.
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Affiliation(s)
- Courtney L Scherr
- Center for Communication and Health, Department of Communication Studies, Northwestern University, 710 North Lake Shore Drive, 15th Floor, Chicago, IL 60611; USA.
| | - Sharon Aufox
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 630, Chicago, IL 60611, USA.
| | - Amy A Ross
- Center for Communication and Health, Department of Communication Studies, Northwestern University, 710 North Lake Shore Drive, 15th Floor, Chicago, IL 60611; USA.
| | - Sanjana Ramesh
- Center for Communication and Health, Department of Communication Studies, Northwestern University, 710 North Lake Shore Drive, 15th Floor, Chicago, IL 60611; USA.
| | - Catherine A Wicklund
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 630, Chicago, IL 60611, USA.
| | - Maureen Smith
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 630, Chicago, IL 60611, USA.
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First, do no harm: direct-to-consumer genetic testing. Genet Med 2018; 21:510-511. [PMID: 29904164 DOI: 10.1038/s41436-018-0071-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 11/08/2022] Open
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Schaper M, Schicktanz S. Medicine, market and communication: ethical considerations in regard to persuasive communication in direct-to-consumer genetic testing services. BMC Med Ethics 2018; 19:56. [PMID: 29871685 PMCID: PMC5989449 DOI: 10.1186/s12910-018-0292-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/16/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Commercial genetic testing offered over the internet, known as direct-to-consumer genetic testing (DTC GT), currently is under ethical attack. A common critique aims at the limited validation of the tests as well as the risk of psycho-social stress or adaption of incorrect behavior by users triggered by misleading health information. Here, we examine in detail the specific role of advertising communication of DTC GT companies from a medical ethical perspective. Our argumentative analysis departs from the starting point that DTC GT operates at the intersection of two different contexts: medicine on the one hand and the market on the other. Both fields differ strongly with regard to their standards of communication practices and the underlying normative assumptions regarding autonomy and responsibility. METHODS Following a short review of the ethical contexts of medical and commercial communication, we provide case examples for persuasive messages of DTC GT websites and briefly analyze their design with a multi-modal approach to illustrate some of their problematic implications. RESULTS We observe three main aspects in DTC GT advertising communication: (1) the use of material suggesting medical professional legitimacy as a trust-establishing tool, (2) the suggestion of empowerment as a benefit of using DTC GT services and (3) the narrative of responsibility as a persuasive appeal to a moral self-conception. CONCLUSIONS While strengthening and respecting the autonomy of a patient is the focus in medical communication, specifically genetic counselling, persuasive communication is the normal mode in marketing of consumer goods, presuming an autonomous, rational, independent consumer. This creates tension in the context of DTC GT regarding the expectation and normative assessment of communication strategies. Our analysis can even the ground for a better understanding of ethical problems associated with intersections of medical and commercial communication and point to perspectives of analysis of DTC GT advertising.
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Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
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Stewart KFJ, Wesselius A, Schols AMWJ, Zeegers MP. Stages of behavioural change after direct-to-consumer disease risk profiling: study protocol of two integrated controlled pragmatic trials. Trials 2018; 19:240. [PMID: 29673375 PMCID: PMC5907695 DOI: 10.1186/s13063-018-2630-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 04/06/2018] [Indexed: 11/24/2022] Open
Abstract
Background The incidence and prevalence of chronic diseases have reached epidemic proportions during the last decades and are not expected to diminish. Chronic diseases increasingly affect younger individuals too, with over 40% of all deaths due to non-communicable diseases occurring before the age of 70. This has led to the development of information services aimed at preventive health care, such as Health Potential®. This counselling service estimates a personal disease risk of a carefully selected list of preventable common chronic diseases that have both a genetic and a lifestyle component of development. The results are delivered face-to-face by a lifestyle counsellor, simultaneously stimulating initial steps towards behaviour change. This information can assist in lifestyle decision-making. Methods/design The primary aim is to study the effect of the Health Potential® service on change in lifestyle behaviour in distinguishable customer populations. The secondary aims are (1) to study the effect of the Health Potential® service on determinants of behaviour change, (2) to study the effect of additional lifestyle counselling on behaviour change and determinants thereof, and (3) to describe the characteristics of the Health Potential® customer. The study consists of two integrated designs: (A) a two-armed non-randomised controlled pre-test/post-test trial (1.5:1 ratio), followed by (B) a two-armed randomised controlled pre-test/post-test trial (1:1 ratio), resulting in three study arms. Participants are clients of local prevention clinics, purchasing a personalised health check (PHC; intervention condition), consisting of Health Potential® and a general health check, or the general health check alone (GHC; control condition) (part A). PHC participants will be randomised to receive four additional lifestyle counselling sessions over a period of 3 months (part B). Discussion This research can provide valuable insights into the effectiveness of and possible ways forward in the field of personalised prevention making use of lifestyle interventions enriched with modern genetic advancements. Trial registration Nederlands Trial Register, NTR6289 and NTR6288. Registered on 24 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2630-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelly F J Stewart
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Anke Wesselius
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Berrios C, James CA, Raraigh K, Bollinger J, Murray B, Tichnell C, Applegate CD, Bergner AL. Enrolling Genomics Research Participants through a Clinical Setting: the Impact of Existing Clinical Relationships on Informed Consent and Expectations for Return of Research Results. J Genet Couns 2018; 27:263-273. [PMID: 28932961 PMCID: PMC7539290 DOI: 10.1007/s10897-017-0143-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
Genetic counselors working in a clinical setting may find themselves recruiting, enrolling, and returning results for genomic research, and existing clinical relationships with study participants may impact these research interactions. We present a qualitative study using semi-structured interviews of participants enrolled in a genome sequencing/exome sequencing (GS/ES) study at the same institution where they receive clinical care. Interviews were coded for motivations to participate and expectations of this research. The interviews revealed common motivations for participation, including altruism and hope for benefit for themselves, family members, and/or others with their condition. Additionally, themes emerged related to unintentional influence based on trust of the clinical provider that recruited them to the study. Participant trust in the enrolling provider at times appeared to extend to the study team to decide which research results to return and to do so in an appropriate format. Participants also based expectations for research results return on previous clinical genetic testing experiences, which may or may not be realistic depending on study design. It is imperative that genetic counselors enrolling patients into research studies be aware of the potential influence of their clinical relationship on potential subjects, be transparent about their role on the study team, and help set expectations about the study process, including results return.
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Affiliation(s)
- Courtney Berrios
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Raraigh
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn D Applegate
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Amanda L Bergner
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA.
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Gollust SE, Gray SW, Carere DA, Koenig BA, Lehmann LS, McGUIRE AL, Sharp RR, Spector-Bagdady K, Wang NA, Green RC, Roberts JS. Consumer Perspectives on Access to Direct-to-Consumer Genetic Testing: Role of Demographic Factors and the Testing Experience. Milbank Q 2018; 95:291-318. [PMID: 28589610 DOI: 10.1111/1468-0009.12262] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Stacy W Gray
- City of Hope Comprehensive Cancer Center, Beckman Research Institute
| | | | | | | | - Amy L McGUIRE
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | | | | | - N A Wang
- Data Coordinating Center, Boston University School of Public Health
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- see acknowledgments for list of nonauthor members of the PGen Study Group
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Walser SA, Werner-Lin A, Mueller R, Miller VA, Biswas S, Bernhardt BA. How do providers discuss the results of pediatric exome sequencing with families? Per Med 2017; 14:409-422. [PMID: 28966657 DOI: 10.2217/pme-2017-0015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM This study provides preliminary data on the process and content of returning results from exome sequencing offered to children through one of the Clinical Sequencing Exploratory Research (CSER) projects. MATERIALS & METHODS We recorded 25 sessions where providers returned diagnostic and secondary sequencing results to families. Data interpretation utilized inductive thematic analysis. RESULTS Typically, providers followed a results report and discussed diagnostic findings using technical genomic and sequencing concepts. We identified four provider processes for returning results: teaching genetic concepts; assessing family response; personalizing findings; and strengthening patient-provider relationships. CONCLUSION Sessions should reflect family interest in medical management and next steps, and minimize detailed genomic concepts. As the scope and complexity of sequencing increase, the traditional information-laden counseling model requires revision.
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Affiliation(s)
- Sarah A Walser
- Translational Medicine & Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allison Werner-Lin
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca Mueller
- Department of History & Sociology of Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 9104, USA
| | - Sawona Biswas
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Barbara A Bernhardt
- Translational Medicine & Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Behavioural changes, sharing behaviour and psychological responses after receiving direct-to-consumer genetic test results: a systematic review and meta-analysis. J Community Genet 2017; 9:1-18. [PMID: 28664264 PMCID: PMC5752648 DOI: 10.1007/s12687-017-0310-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/08/2017] [Indexed: 01/22/2023] Open
Abstract
It has been hypothesised that direct-to-consumer genetic tests (DTC-GTs) could stimulate health behaviour change. However, genetic testing may also lead to anxiety and distress or unnecessarily burden the health care system. The aim is to review and meta-analyse the effects of DTC-GT on (1) behaviour change, (2) psychological response and (3) medical consumption. A systematic literature search was performed in three databases, using "direct-to-consumer genetic testing" as a key search term. Random effects meta-analyses were performed when at least two comparable outcomes were available. After selection, 19 articles were included involving 11 unique studies. Seven studies involved actual consumers who paid the retail price, whereas four included participants who received free genetic testing as part of a research trial (non-actual consumers). In meta-analysis, 23% had a positive lifestyle change. More specifically, improved dietary and exercise practices were both reported by 12%, whereas 19% quit smoking. Seven percent of participants had subsequent preventive checks. Thirty-three percent shared their results with any health care professional and 50% with family and/or friends. Sub-analyses show that behaviour change was more prevalent among non-actual consumers, whereas sharing was more prevalent among actual consumers. Results on psychological responses showed that anxiety, distress and worry were low or absent and that the effect faded with time. DTC-GT has potential to be effective as a health intervention, but the right audience needs to be addressed with tailored follow-up. Research is needed to identify consumers who do and do not change behaviour or experience adverse psychological responses.
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Hylind R, Smith M, Rasmussen-Torvik L, Aufox S. Great expectations: patient perspectives and anticipated utility of non-diagnostic genomic-sequencing results. J Community Genet 2017; 9:19-26. [PMID: 28656483 DOI: 10.1007/s12687-017-0314-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/14/2017] [Indexed: 12/22/2022] Open
Abstract
The management of secondary findings is a challenge to health-care providers relaying clinical genomic-sequencing results to patients. Understanding patients' expectations from non-diagnostic genomic sequencing could help guide this management. This study interviewed 14 individuals enrolled in the eMERGE (Electronic Medical Records and Genomics) study. Participants in eMERGE consent to undergo non-diagnostic genomic sequencing, receive results, and have results returned to their physicians. The interviews assessed expectations and intended use of results. The majority of interviewees were male (64%) and 43% identified as non-Caucasian. A unique theme identified was that many participants expressed uncertainty about the type of diseases they expected to receive results on, what results they wanted to learn about, and how they intended to use results. Participant uncertainty highlights the complex nature of deciding to undergo genomic testing and a deficiency in genomic knowledge. These results could help improve how genomic sequencing and secondary findings are discussed with patients.
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Affiliation(s)
- Robyn Hylind
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
| | - Maureen Smith
- Department of Center of Genetic Medicine, Northwestern University, Chicago, IL, USA
| | | | - Sharon Aufox
- Department of Center for Genetic Medicine, Northwestern University, Chicago, IL, USA
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Ethical considerations in genomic testing for hematologic disorders. Blood 2017; 130:460-465. [PMID: 28600340 DOI: 10.1182/blood-2017-01-734558] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/14/2017] [Indexed: 12/18/2022] Open
Abstract
As our technological capacities improve, genomic testing is increasingly integrating into patient care. The field of clinical hematology is no exception. Genomic testing carries great promise, but several ethical issues must be considered whenever such testing is performed. This review addresses these ethical considerations, including issues surrounding informed consent and the uncertainty of the results of genomic testing; the challenge of incidental findings; and possible inequities in access to and benefit from such testing. Genomic testing is likely to transform the practice of both benign and malignant hematology, but clinicians must carefully consider these core ethical issues in order to make the most of this exciting and evolving technology.
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Motivation, Perception, and Treatment Beliefs in the Myocardial Infarction Genes (MI-GENES) Randomized Clinical Trial. J Genet Couns 2017; 26:1153-1161. [DOI: 10.1007/s10897-017-0092-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
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Sweet K, Sturm AC, Schmidlen T, McElroy J, Scheinfeldt L, Manickam K, Gordon ES, Hovick S, Scott Roberts J, Toland AE, Christman M. Outcomes of a Randomized Controlled Trial of Genomic Counseling for Patients Receiving Personalized and Actionable Complex Disease Reports. J Genet Couns 2017; 26:980-998. [PMID: 28345121 DOI: 10.1007/s10897-017-0073-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
There has been very limited study of patients with chronic disease receiving potentially actionable genomic based results or the utilization of genetic counselors in the online result delivery process. We conducted a randomized controlled trial on 199 patients with chronic disease each receiving eight personalized and actionable complex disease reports online. Primary study aims were to assess the impact of in-person genomic counseling on 1) causal attribution of disease risk, 2) personal awareness of disease risk, and 3) perceived risk of developing a particular disease. Of 98 intervention arm participants (mean age = 57.8; 39% female) randomized for in-person genomic counseling, 76 (78%) were seen. In contrast, control arm participants (n = 101; mean age = 58.5; 54% female) were initially not offered genomic counseling as part of the study protocol but were able to access in-person genomic counseling, if they requested it, 3-months post viewing of at least one test report and post-completion of the study-specific follow-up survey. A total of 64 intervention arm and 59 control arm participants completed follow-up survey measures. We found that participants receiving in-person genomic counseling had enhanced objective understanding of the genetic variant risk contribution for multiple complex diseases. Genomic counseling was associated with lowered participant causal beliefs in genetic influence across all eight diseases, compared to control participants. Our findings also illustrate that for the majority of diseases under study, intervention arm participants believed they knew their genetic risk status better than control arm subjects. Disease risk was modified for the majority during genomic counseling, due to the assessment of more comprehensive family history. In conclusion, for patients receiving personalized and actionable genomic results through a web portal, genomic counseling enhanced their objective understanding of the genetic variant risk contribution to multiple common diseases. These results support the development of additional genomic counseling interventions to ensure a high level of patient comprehension and improve patient-centered health outcomes.
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Affiliation(s)
- Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA.
- Division of Human Genetics, Ohio State University, 2001 Polaris Parkway, Columbus, OH, 43212, USA.
| | - Amy C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Tara Schmidlen
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
| | - Joseph McElroy
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, 43221, USA
| | - Laura Scheinfeldt
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Temple University, SERC Building, 1925 N. 12th St, Philadelphia, PA, 19122-1801, USA
| | - Kandamurugu Manickam
- Geisinger Health System, Genomic Medicine Institute, Precision Health Center, 190 Welles Street, Suite 128, Forty Fort, PA, 18704, USA
| | - Erynn S Gordon
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Genome Medical, Monterey, CA, 93940, USA
| | - Shelly Hovick
- School of Communication, Ohio State University, Columbus, OH, 43214, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Amanda Ewart Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Michael Christman
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
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Research Participants’ Preferences for Hypothetical Secondary Results from Genomic Research. J Genet Couns 2016; 26:841-851. [DOI: 10.1007/s10897-016-0059-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Gray SW, Gollust SE, Carere DA, Chen CA, Cronin A, Kalia SS, Rana HQ, Ruffin MT, Wang C, Roberts JS, Green RC. Personal Genomic Testing for Cancer Risk: Results From the Impact of Personal Genomics Study. J Clin Oncol 2016; 35:636-644. [PMID: 27937091 DOI: 10.1200/jco.2016.67.1503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Significant concerns exist regarding the potential for unwarranted behavior changes and the overuse of health care resources in response to direct-to-consumer personal genomic testing (PGT). However, little is known about customers' behaviors after PGT. Methods Longitudinal surveys were given to new customers of 23andMe (Mountain View, CA) and Pathway Genomics (San Diego, CA). Survey data were linked to individual-level PGT results through a secure data transfer process. Results Of the 1,042 customers who completed baseline and 6-month surveys (response rate, 71.2%), 762 had complete cancer-related data and were analyzed. Most customers reported that learning about their genetic risk of cancers was a motivation for testing (colorectal, 88%; prostate, 95%; breast, 94%). No customers tested positive for pathogenic mutations in highly penetrant cancer susceptibility genes. A minority of individuals received elevated single nucleotide polymorphism-based PGT cancer risk estimates (colorectal, 24%; prostate, 24%; breast, 12%). At 6 months, customers who received elevated PGT cancer risk estimates were not significantly more likely to change their diet, exercise, or advanced planning behaviors or engage in cancer screening, compared with individuals at average or reduced risk. Men who received elevated PGT prostate cancer risk estimates changed their vitamin and supplement use more than those at average or reduced risk (22% v 7.6%, respectively; adjusted odds ratio, 3.41; 95% CI, 1.44 to 8.18). Predictors of 6-month behavior include baseline behavior (exercise, vitamin or supplement use, and screening), worse health status (diet and vitamin or supplement use), and older age (advanced planning, screening). Conclusion Most adults receiving elevated direct-to-consumer PGT single nucleotide polymorphism-based cancer risk estimates did not significantly change their diet, exercise, advanced care planning, or cancer screening behaviors.
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Affiliation(s)
- Stacy W Gray
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah E Gollust
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Deanna Alexis Carere
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Clara A Chen
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Angel Cronin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah S Kalia
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Huma Q Rana
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Mack T Ruffin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Catharine Wang
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - J Scott Roberts
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Robert C Green
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
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Sweet K, Hovick S, Sturm AC, Schmidlen T, Gordon E, Bernhardt B, Wawak L, Wernke K, McElroy J, Scheinfeldt L, Toland AE, Roberts JS, Christman M. Counselees' Perspectives of Genomic Counseling Following Online Receipt of Multiple Actionable Complex Disease and Pharmacogenomic Results: a Qualitative Research Study. J Genet Couns 2016; 26:738-751. [PMID: 27921197 DOI: 10.1007/s10897-016-0044-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
Genomic applications raise multiple challenges including the optimization of genomic counseling (GC) services as part of the results delivery process. More information on patients' motivations, preferences, and informational needs are essential to guide the development of new, more efficient practice delivery models that capitalize on the existing strengths of a limited genetic counseling workforce. Semi-structured telephone interviews were conducted with a subset of counselees from the Coriell Personalized Medicine Collaborative following online receipt of multiple personalized genomic test reports. Participants previously had either in-person GC (chronic disease cohort, n = 20; mean age 60 years) or telephone GC (community cohort, n = 31; mean age 46.8 years). Transcripts were analyzed using a Grounded Theory framework. Major themes that emerged from the interviews include 1) primary reasons for seeking GC were to clarify results, put results into perspective relative to other health-related concerns, and to receive personalized recommendations; 2) there is need for a more participant driven approach in terms of mode of GC communication (in-person, phone, video), and refining the counseling agenda pre-session; and 3) there was strong interest in the option of follow up GC. By clarifying counselees' expectations, views and desired outcomes, we have uncovered a need for a more participant-driven GC model when potentially actionable genomic results are received online.
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Affiliation(s)
- Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA.
| | - Shelly Hovick
- School of Communication, Ohio State University, Columbus, OH, 43214, USA
| | - Amy C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Tara Schmidlen
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
| | | | - Barbara Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lisa Wawak
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
| | - Karen Wernke
- Division of Human Genetics, Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA
| | - Joseph McElroy
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, 43221, USA
| | - Laura Scheinfeldt
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA.,Temple University, SERC Building 1925 N. 12th St, Philadelphia, PA, 19122-1801, USA
| | - Amanda E Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA
| | - J S Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael Christman
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
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50
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Cheung C, Bietz MJ, Patrick K, Bloss CS. Privacy Attitudes among Early Adopters of Emerging Health Technologies. PLoS One 2016; 11:e0166389. [PMID: 27832194 PMCID: PMC5104519 DOI: 10.1371/journal.pone.0166389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Advances in health technology such as genome sequencing and wearable sensors now allow for the collection of highly granular personal health data from individuals. It is unclear how people think about privacy in the context of these emerging health technologies. An open question is whether early adopters of these advances conceptualize privacy in different ways than non-early adopters. PURPOSE This study sought to understand privacy attitudes of early adopters of emerging health technologies. METHODS Transcripts from in-depth, semi-structured interviews with early adopters of genome sequencing and health devices and apps were analyzed with a focus on participant attitudes and perceptions of privacy. Themes were extracted using inductive content analysis. RESULTS Although interviewees were willing to share personal data to support scientific advancements, they still expressed concerns, as well as uncertainty about who has access to their data, and for what purpose. In short, they were not dismissive of privacy risks. Key privacy-related findings are organized into four themes as follows: first, personal data privacy; second, control over personal information; third, concerns about discrimination; and fourth, contributing personal data to science. CONCLUSION Early adopters of emerging health technologies appear to have more complex and nuanced conceptions of privacy than might be expected based on their adoption of personal health technologies and participation in open science. Early adopters also voiced uncertainty about the privacy implications of their decisions to use new technologies and share their data for research. Though not representative of the general public, studies of early adopters can provide important insights into evolving attitudes toward privacy in the context of emerging health technologies and personal health data research.
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Affiliation(s)
- Cynthia Cheung
- Center for Wireless and Population Health Systems, Calit2, University of California San Diego, La Jolla, California, United States of America
| | - Matthew J. Bietz
- Center for Wireless and Population Health Systems, Calit2, University of California San Diego, La Jolla, California, United States of America
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, California, United States of America
| | - Kevin Patrick
- Center for Wireless and Population Health Systems, Calit2, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Cinnamon S. Bloss
- Center for Wireless and Population Health Systems, Calit2, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, United States of America
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