1
|
Burke K, Dawson L, Hodgkinson K, Wilson BJ, Etchegary H. Exploring family communication preferences in hereditary breast and ovarian cancer and Lynch syndrome: a national Canadian survey. J Community Genet 2024:10.1007/s12687-024-00720-z. [PMID: 39046652 DOI: 10.1007/s12687-024-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Individuals affected with cancer predisposition (CPS) syndromes such as BRCA1, BRCA2 or Lynch syndrome (LS) are at an elevated risk of multiple cancers. Identifying high-risk individuals is important if they are to access risk-reducing strategies. Interventions such as risk-reducing salpingo-oophorectomy in carriers of BRCA pathogenic or likely pathogenic (P/LP) variants or regular colonoscopy for carriers of LS P/LP variants are highly effective and reduce mortality. Despite clear evidence that the identification of at-risk relatives has value, the uptake of cascade testing remains at approximately 50%. It is important to understand strategies and barriers to testing to facilitate communication in families identified as haveing a hereditary cancer syndrome, to improve uptake of counselling and testing. METHOD A national online survey of both Canadian probands (the first member in a family to have genetic testing and who were variant positive, regardless of a cancer diagnosis) and their at-risk relatives. Respondents were individuals affected with hereditary breast and ovarian cancer (HBOC) and LS. The survey was constructed based on a review of the literature and authors' feedback. Both open and closed-ended questions were used for items on demographic characteristics, risk perception, genetic test results and cancer diagnosis. Items on experiences with hereditary cancer risk communication, communication challenges, preferences and supports required were explored using a 5-point Likert scale. RESULTS Responses indicated a high level of acceptance for the proband's direct involvement in family communication with the support of a health care provider (67% among the probands given a family letter and 55-57% among those who were not given a family letter). Respondents without a personal history of cancer were more likely to endorse a health care professional's help with family communication compared to those with a personal history of cancer (p = 0.031). Preferences for family member outreach also varied by education level, annual income, marital status and geographic location. Similarities were noted between the probands and relatives on communication outreach preferences. CONCLUSION While the family-mediated approach to communication remains the standard across many cancer genetics programs, participants note that additional support is necessary for dissemination of result information among relatives. Because family dynamics and communication vary widely, alternative options that retain the probands' involvement in family communication but add support from a health care provider should be explored.
Collapse
Affiliation(s)
- Kimberly Burke
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada.
| | - Lesa Dawson
- Faculty of Medicine, Discipline of Obstetrics and Gynecology, Memorial University, St. John's, NL, Canada
- Division of Gynecologic Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen Hodgkinson
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
- Faculty of Medicine, Division of BioMedical Sciences, Memorial University, St. John's, NL, Canada
| | - Brenda J Wilson
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - Holly Etchegary
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| |
Collapse
|
2
|
Fukuzaki N, Kiyozumi Y, Higashigawa S, Horiuchi Y, Matsubayashi H, Nishimura S, Mori K, Notsu A, Suishu I, Ohnami S, Kusuhara M, Yamaguchi K, Doorenbos AZ, Takeda Y. A Cross-sectional Study of Regret in Cancer Patients After Sharing Test Results for Pathogenic Germline Variants of Hereditary Cancers With Relatives. Cancer Nurs 2024; 47:281-289. [PMID: 36881649 DOI: 10.1097/ncc.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Research on whole genome/exome sequencing is increasing worldwide. However, challenges are emerging in relation to receiving germline pathogenic variant results and sharing them with relatives. OBJECTIVE The aim of this study was to investigate the occurrence of and reasoning related to regret among patients with cancer who shared single-gene testing results and whole exome sequencing with family members. METHODS This was a single-center, cross-sectional study. The Decision Regret Scale was administered, and descriptive questionnaires were used with 21 patients with cancer. RESULTS Eight patients were classified as having no regret, 9 patients were classified as having mild regret, and 4 patients were classified as having moderate to strong regret. Reasons patients felt that sharing was the right decision included the following: to allow relatives and children to take preventive measures, the need for both parties to be aware of and ready for the hereditary transmission of cancer, and the need to be able to discuss the situation with others. On the other hand, some patients did not think it was a good decision to share the information because of the associated anxiety. CONCLUSIONS Regret over sharing test results for pathogenic germline variants of hereditary cancers with relatives tended to be low. The main reason was that patients believed that they were able to benefit others by sharing. IMPLICATIONS FOR PRACTICE Healthcare professionals need to understand the postsharing perceptions and experiences of patients and support them throughout the sharing process.
Collapse
Affiliation(s)
- Naomi Fukuzaki
- Author Affiliations: Department of Nursing, Shizuoka Cancer Center Hospital (Dr Fukuzaki and Ms Suishu); Division of Genetic Medicine Promotion, Shizuoka Cancer Center (Drs Kiyozumi, Horiuchi, and Matsubayashi; Ms Higashigawa; Dr Nishimura); Tokyo Metropolitan Institute of Medical Science (Dr Horiuchi); Division of Endoscopy, Shizuoka Cancer Center (Dr Matsubayashi); Division of Breast Surgery, Shizuoka Cancer Center Hospital (Dr Nishimura); Clinical Research Center, Shizuoka Cancer Center (Drs Mori and Notsu); Shizuoka Cancer Center Research Institute (Ms Ohnami and Dr Kusuhara); and Shizuoka Cancer Center (Dr Yamaguchi), Japan; Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago (Dr Doorenbos); and Graduate School of Health Management, Keio University (Dr Takeda), Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Levine R, Kahn RM, Perez L, Brewer J, Ratner S, Li X, Yeoshoua E, Frey MK. Cascade genetic testing for hereditary cancer syndromes: a review of barriers and breakthroughs. Fam Cancer 2024; 23:111-120. [PMID: 38530571 DOI: 10.1007/s10689-024-00373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
Germline genetic sequencing is now at the forefront of cancer treatment and preventative medicine. Cascade genetic testing, or the testing of at-risk relatives, is extremely promising as it offers genetic testing and potentially life-saving risk-reduction strategies to a population exponentially enriched for the risk of carrying a cancer-associated pathogenic variant. However, many relatives do not complete cascade testing due to barriers that span individual, relationship, healthcare community, and societal/policy domains. We have reviewed the published research on cascade testing. Our aim is to evaluate barriers to cascade genetic testing for hereditary cancer syndromes and explore strategies to mitigate these barriers, with the goal of promoting increased uptake of cascade genetic testing.
Collapse
Affiliation(s)
- Rachel Levine
- Department of Obstetrics and Gynecology, HCA Florida Brandon, Brandon, FL, USA.
| | - Ryan M Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luiza Perez
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Jesse Brewer
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Samantha Ratner
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Xuan Li
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Effi Yeoshoua
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa K Frey
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, NY, USA
- Genetics and Personalized Cancer Prevention Program, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
4
|
Adelson SM, Blout Zawatsky CL, Hickingbotham MR, Bell ME, Platt DM, Leonhard JR, Zoltick ES, Hajek CA, Green RC, Christensen KD. Familial communication and cascade testing following elective genomic testing. J Genet Couns 2024. [PMID: 38757439 DOI: 10.1002/jgc4.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Familial communication of results and cascade genetic testing (CGT) can extend the benefits of genetic screening beyond the patient to their at-risk relatives. While an increasing number of health systems are offering genetic screening as an elective clinical service, data are limited about how often results are shared and how often results lead to CGT. From 2018 to 2022, the Sanford Health system offered the Sanford Chip, an elective genomic test that included screening for medically actionable predispositions for disease recommended by the American College of Medical Genetics and Genomics for secondary findings disclosure, to its adult primary care patients. We analyzed patient-reported data about familial sharing of results and CGT among patients who received Sanford Chip results at least 1 year previously. Among the patients identified with medically actionable predispositions, 94.6% (53/56) reported disclosing their result to at least one family member, compared with 46.7% (423/906) of patients with uninformative findings (p < 0.001). Of the patients with actionable predispositions, 52.2% (12/23) with a monogenic disease risk and 12.1% (4/33) with a carrier status reported that their relatives underwent CGT. Results suggest that while the identification of monogenic risk during elective genomic testing motivates CGT in many at-risk relatives, there remain untested at-risk relatives who may benefit from future CGT. Findings identify an area that may benefit from increased genetic counseling and the development of tools and resources to encourage CGT for family members.
Collapse
Affiliation(s)
- Sophia M Adelson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Ariadne Labs, Boston, Massachusetts, USA
- Department of Genetics, Human Genetics and Genetic Counseling, Stanford University School of Medicine, Stanford, California, USA
| | - Carrie L Blout Zawatsky
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Ariadne Labs, Boston, Massachusetts, USA
| | - Madison R Hickingbotham
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Megan E Bell
- Sanford Health Imagenetics, Sioux Falls, South Dakota, USA
| | - Dylan M Platt
- Sanford Health Imagenetics, Sioux Falls, South Dakota, USA
| | | | - Emilie S Zoltick
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Catherine A Hajek
- Sanford Health Imagenetics, Sioux Falls, South Dakota, USA
- Helix OpCo, LLC, San Mateo, California, USA
| | - Robert C Green
- Ariadne Labs, Boston, Massachusetts, USA
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
- Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Ahsan MD, Levi SR, Webster EM, Bergeron H, Lin J, Narayan P, Nelson BB, Li X, Fowlkes RK, Brewer JT, Thomas C, Christos PJ, Chapman-Davis E, Cantillo E, Holcomb K, Sharaf RN, Frey MK. Do people with hereditary cancer syndromes inform their at-risk relatives? A systematic review and meta-analysis. PEC INNOVATION 2023; 2:100138. [PMID: 37214514 PMCID: PMC10194207 DOI: 10.1016/j.pecinn.2023.100138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 05/24/2023]
Abstract
Purpose To evaluate rates of familial disclosure of hereditary cancer syndrome information. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO no.: CRD42020134276). Key electronic databases were searched to identify studies evaluating hereditary cancer syndrome cascade relative disclosure. Eligible studies were subjected to meta-analysis. Results Thirty-four studies met inclusion criteria. Among 11,711 included relatives, 70% (95% CI 60 - 78%) were informed of their risk of carrying a cancer-associated pathogenic variant; of 2,875 relatives informed of their risk who were evaluated for uptake of cascade testing, 43% (95% CI 27 - 61%) completed testing. Rates of disclosure were higher among female vs male relatives (79% [95% CI 73% - 84%] vs 67% [95% CI 57% - 75%]) and first-degree vs second-degree relatives (83% [95% CI 77% - 88%] vs 58% [95% CI 45 - 69%]). Conclusion Nearly one-third of at-risk relatives remain uninformed of their risk of carrying a cancer-associated pathogenic variant. Even among those informed, fewer than half subsequently complete genetic testing, representing a critical missed opportunity for precision cancer prevention. Innovation Five studies evaluating interventions to improve disclosure rates were generally ineffective. Urgent work is needed to elucidate barriers to relative disclosure by probands to develop targeted interventions that can optimize proband-mediated cascade genetic testing rates.
Collapse
Affiliation(s)
- Muhammad Danyal Ahsan
- Corresponding author at: Division of Gynecologic Oncology, Weill Cornell Medicine, United States of America
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Baroutsou V, Duong V, Signorini A, Saccilotto R, Ciorba FM, Bürki N, Caiata-Zufferey M, Ryu JM, Kim SW, Lim MC, Monnerat C, Zürrer-Härdi U, Kim J, Heinimann K, Graffeo R, Park JS, Rabaglio M, Chappuis PO, Kim S, Katapodi MC. Acceptability and Usability of the Family Gene Toolkit for Swiss and Korean Families Harboring BRCA1/BRAC2 Pathogenic Variants: A Web-Based Platform for Cascade Genetic Testing. Cancers (Basel) 2023; 15:4485. [PMID: 37760455 PMCID: PMC10527353 DOI: 10.3390/cancers15184485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The study adapted the Family Gene Toolkit and developed a customized web application for Swiss and Korean families harboring BRCA1 or BRCA2 pathogenic variants to support family communication of genetic testing results and promote cascade genetic testing among at-risk relatives. In the first step, narrative data from 68 women with BRCA1/BRCA2 pathogenic variants and clinician feedback informed a culturally sensitive adaptation of the content consistent with current risk management guidelines. In the second step, the Information Technology team developed the functions and the interface of the web application that will host the intervention. In the third step, a new sample of 18 women from families harboring BRCA1/BRCA2 pathogenic variants tested the acceptability and usability of the intervention using "think-aloud" interviews and a questionnaire. Participants expressed high levels of satisfaction with the intervention. They provided positive feedback for the information regarding active coping, strategies to enhance family communication, interactive elements, and illustrative stories. They reported that the information was useful and the web application was easy to navigate. Findings suggest that the Family Gene Toolkit is well-designed and can increase rates of cascade testing among at-risk relatives. Its efficacy will be tested in a subsequent randomized trial.
Collapse
Affiliation(s)
- Vasiliki Baroutsou
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Vu Duong
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Alice Signorini
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Ramon Saccilotto
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Florina M. Ciorba
- Department of Mathematics and Computer Science, University of Basel, 4051 Basel, Switzerland;
| | - Nicole Bürki
- Women’s Clinic, University Hospital Basel, 4031 Basel, Switzerland;
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Sung-Won Kim
- Department of Breast Surgery, Breast Care Center, Dairim St Mary’s Hospital, Seoul 07442, Republic of Korea;
| | - Myong Cheol Lim
- Division of Tumor Immunology, Center for Gynecologic Cancer Research Institute and Hospital, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Christian Monnerat
- Department of Medical Oncology, Hospital of Jura, 2800 Delemont, Switzerland;
| | - Ursina Zürrer-Härdi
- Department of Medical Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland;
- Research Group Human Genomics, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Rossella Graffeo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland;
| | - Ji Soo Park
- Hereditary Cancer Clinic, Cancer Prevention Center, Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03772, Republic of Korea;
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Pierre Olivier Chappuis
- Unit of Oncogenetics, Division of Precision Oncology, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Division of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul 03722, Republic of Korea;
| | - Maria C. Katapodi
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | | |
Collapse
|
7
|
Barnoy S, Dagan E, Kim S, Caiata-Zufferey M, Katapodi MC. Privacy and utility of genetic testing in families with hereditary cancer syndromes living in three countries: the international cascade genetic screening experience. Front Genet 2023; 14:1109431. [PMID: 37229185 PMCID: PMC10203600 DOI: 10.3389/fgene.2023.1109431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Hereditary breast and ovarian cancer and Lynch syndrome are associated with increased lifetime risk for common cancers. Offering cascade genetic testing to cancer-free relatives of individuals with HBOC or LS is a public health intervention for cancer prevention. Yet, little is known about the utility and value of information gained from cascade testing. This paper discusses ELSI encountered during the implementation of cascade testing in three countries with national healthcare systems: Switzerland, Korea, and Israel. Methods: A workshop presented at the 5th International ELSI Congress discussed implementation of cascade testing in the three countries based on exchange of data and experiences from the international CASCADE cohort. Results: Analyses focused on models of accessing genetic services (clinic-based versus population-based screening), and models of initiating cascade testing (patient-mediated dissemination versus provider-mediated dissemination of testing results to relatives). The legal framework of each country, organization of the healthcare system, and socio-cultural norms determined the utility and value of genetic information gained from cascade testing. Conclusion: The juxtaposition of individual versus public health interests generates significant ELSI controversies associated with cascade testing, which compromise access to genetic services and the utility and value of genetic information, despite national healthcare/universal coverage.
Collapse
Affiliation(s)
- Sivia Barnoy
- Department of Nursing, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | |
Collapse
|
8
|
Chen L, Chen M. Danger control and fear control during public health emergencies: Considering the roles of fear and hope in the EPPM across different levels of trust. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:928-942. [PMID: 35750328 DOI: 10.1111/risa.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Public health emergencies pose considerable threats to global health and safety. The control of these emergencies requires the efforts of healthcare professionals and calls for the public to take protective actions. The present study not only puts fear back in the extended parallel process model (EPPM) but also considers another similarly productive emotion: hope. We examined the mechanisms behind the effects of four cognitive perceptions on protective actions (i.e., danger control) and information avoidance (i.e., fear control). A national online survey was conducted with 1676 participants during the outbreak of COVID-19 in China from February 1 to 29, 2020. The results revealed that perceived severity and susceptibility could lead to fear, positively affecting protective actions. On the other hand, perceived response efficacy and self-efficacy induced hope, which was positively associated with protective actions but negatively associated with information avoidance. Furthermore, the mechanisms behind the relationships among cognitions, emotions, and behaviors varied across levels of trust in healthcare systems.
Collapse
Affiliation(s)
- Liang Chen
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Minyi Chen
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore
| |
Collapse
|
9
|
Winskill C, Goodman MS, Daly BM, Elrick A, Mooney R, Espinel W, Kohlmann W, Kaphingst KA. Predictors of Women's Intentions to Communicate Updated Genetic Test Results to Immediate and Extended Family Members. Public Health Genomics 2023; 26:24-34. [PMID: 36642066 PMCID: PMC10015742 DOI: 10.1159/000528522] [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: 03/03/2022] [Accepted: 11/28/2022] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Many individuals who previously received negative genetic test results are eligible for updated testing. This study examined intention to communicate updated genetic test results to relatives in participants who previously received negative genetic test results. METHODS Women with a personal or family history of breast or ovarian cancer who tested negative for BRCA1/2 before 2013 were enrolled between April 2018 and October 2019. Proportions were calculated to assess intention to communicate updated genetic test results to living immediate family, extended family, and all family. Potential predictors of intentions from the theory of planned behavior (attitudes, subjective norms, perceived behavioral control) were assessed. The three outcomes were analyzed using generalized linear models with a quasi-binomial probability distribution. RESULTS 110 women completed the baseline assessment prior to updated testing. Participants intended to communicate genetic test results to 90% of immediate family, 51% of extended family, and 66% of all living relatives. Participants with higher subjective norms (aOR = 1.93, 95% CI: 1.08-3.57) had higher intentions to communicate genetic test results to extended family, while participants with more positive attitudes (aOR = 1.27, 95% CI: 1.01-1.60) had higher intentions to communicate to all family. Placing higher importance on genetic information was associated with higher intentions to communicate to immediate family (aOR = 1.40, 95% CI: 1.06-1.83). Lower subjective numeracy was associated with higher intentions to communicate to extended family (aOR = 0.50, 95% CI: 0.32-0.76). CONCLUSION Attitudes and subjective norms were predictors of intention to communicate updated genetic information to at-risk biological relatives, and predictors may vary by degree of relationship.
Collapse
Affiliation(s)
- Carolyn Winskill
- New York University School of Global Public Health, New York, New York, USA
| | - Melody S. Goodman
- New York University School of Global Public Health, New York, New York, USA
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Ashley Elrick
- Department of Communications, Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Ryan Mooney
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Whitney Espinel
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Kimberly A. Kaphingst
- Department of Communications, Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| |
Collapse
|
10
|
Makhnoon S, Yu R, Peterson SK, Shete S. Clinical Cancer and Direct-to-Consumer Genetic Test Result-Sharing Behavior: Findings from HINTS 2020. J Pers Med 2022; 13:jpm13010018. [PMID: 36675679 PMCID: PMC9866851 DOI: 10.3390/jpm13010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Sharing genetic test results with different stakeholders such as family members, healthcare providers and genetic counselors (HCP/GCs), spouses/partners, and friends is a health behavior of clinical importance in genomic medicine. METHODS Using nationally representative population-based data collected from the Health Information National Trends Survey (HINTS 5, cycle 4), we identified the prevalence and factors associated with genetic test result-sharing behavior for high-risk cancer tests, genetic health risk tests, and ancestry tests within four groups: HCP/GCs, first-degree relatives (FDRs), spouse/partner, and friend/other. RESULTS Overall, 68.4% of those who underwent high-risk cancer genetic testing shared their results with FDRs, whereas 89.9% shared with HCP/GCs. In adjusted multivariable analyses, women were nine times more likely than men to share (p = 0.006), and those with a personal history of cancer were less likely to share with HCP/GCs (OR = 0.025, p ≤ 0.001). Of those tested for genetic health risk, 66.5% shared with HCP/GCs, 38.7% with FDRs, 66.6% with a spouse/partner, 12.8% with a friend, and 14.1% did not share results with anyone. Of those who underwent ancestry testing, very few shared results with HCP/GCs (2.6%), whereas modest sharing was reported with FDRs, spouses/partners, and friends. DISCUSSION These data add empirical evidence about the population prevalence of genetic information sharing and serve as a metric for public engagement with genetic testing.
Collapse
Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Robert Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-745-2483
| |
Collapse
|
11
|
Frey MK, Ahsan MD, Bergeron H, Lin J, Li X, Fowlkes RK, Narayan P, Nitecki R, Rauh-Hain JA, Moss HA, Baltich Nelson B, Thomas C, Christos PJ, Hamilton JG, Chapman-Davis E, Cantillo E, Holcomb K, Kurian AW, Lipkin S, Offit K, Sharaf RN. Cascade Testing for Hereditary Cancer Syndromes: Should We Move Toward Direct Relative Contact? A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:4129-4143. [PMID: 35960887 PMCID: PMC9746789 DOI: 10.1200/jco.22.00303] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Evidence-based guidelines recommend cascade genetic counseling and testing for hereditary cancer syndromes, providing relatives the opportunity for early detection and prevention of cancer. The current standard is for patients to contact and encourage relatives (patient-mediated contact) to undergo counseling and testing. Direct relative contact by the medical team or testing laboratory has shown promise but is complicated by privacy laws and lack of infrastructure. We sought to compare outcomes associated with patient-mediated and direct relative contact for hereditary cancer cascade genetic counseling and testing in the first meta-analysis on this topic. MATERIALS AND METHODS We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42020134276). We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Eligible trials were subjected to meta-analysis. RESULTS Eighty-seven studies met inclusion criteria. Among relatives included in the meta-analysis, 48% (95% CI, 38 to 58) underwent cascade genetic counseling and 41% (95% CI, 34 to 48) cascade genetic testing. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] v 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] v 40% [95% CI, 32 to 48]). Methods of direct contact included telephone calls, letters, and e-mails; respective rates of genetic testing completion were 61% (95% CI, 51 to 70), 48% (95% CI, 37 to 59), and 48% (95% CI, 45 to 50). CONCLUSION Most relatives at risk for hereditary cancer do not undergo cascade genetic counseling and testing, forgoing potentially life-saving medical interventions. Compared with patient-mediated contact, direct relative contact increased rates of cascade genetic counseling and testing, arguing for a shift in the care delivery paradigm, to be confirmed by randomized controlled trials.
Collapse
Affiliation(s)
| | | | | | - Jenny Lin
- Weill Cornell Medicine, New York, NY
| | - Xuan Li
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | |
Collapse
|
12
|
Pfledderer CD, Gren LH, Frost CJ, Andrulis IL, Chung WK, Genkinger J, Glendon G, Hopper JL, John E, Southey M, Terry MB, Daly MB. Women's thoughts on receiving and sharing genetic information: Considerations for genetic counseling. J Genet Couns 2022; 31:1249-1260. [PMID: 35794807 PMCID: PMC10084347 DOI: 10.1002/jgc4.1599] [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: 02/10/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Indications for genetic testing for inherited cancer syndromes are expanding both in the academic and the community setting. However, only a fraction of individuals who are candidates for testing pursue this option. Therefore, it is important to understand those factors that impact the uptake of genetic testing in individuals affected and unaffected with cancer. A successful translation of genomic risk stratification into clinical care will require that providers of this information are aware of the attitudes, perceived risks and benefits, and concerns of individuals who will be considering testing. The purpose of this study was to assess beliefs, attitudes and preferences for genetic risk information, by personal characteristics of women affected and unaffected by breast cancer enrolled in the Breast Cancer Family Registry Cohort. Data for this analysis came from eight survey questions, which asked participants (N = 9,048, 100% female) about their opinions regarding genetic information. Women reported that conveying the accuracy of the test was important and were interested in information related to personal level of risk, finding out about diseases that could be treated, and information that could be helpful to their families. Young women were most interested in how their own health needs might be impacted by genetic test results, while older women were more interested in how genetic information would benefit other members of the family. Interest in how the genetic test was performed was highest among Asian and Hispanic women. Women affected with breast cancer were more likely to report feeling sad about possibly passing down a breast cancer gene, while unaffected women were more uncertain about their future risk of cancer. The variety of informational needs identified has implications for how genetic counselors can tailor communication to individuals considering genetic testing.
Collapse
Affiliation(s)
- Christopher D. Pfledderer
- Department of Exercise Science, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Lisa H. Gren
- Department of Family & Preventive MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Caren J. Frost
- College of Social WorkUniversity of UtahSalt Lake CityUtahUSA
| | - Irene L. Andrulis
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoOntarioCanada
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Jeanine Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public HealthHerbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Gord Glendon
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoOntarioCanada
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Esther M. John
- Department of Epidemiology & Population Health, Department of Medicine (Oncology)Stanford Cancer InstitutePalo AltoCaliforniaUSA
| | - Melissa Southey
- Cancer Epidemiology Division, Cancer Council VictoriaMelbourneAustralia
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public HealthHerbert Irving Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Mary B. Daly
- Fox Chase Cancer Center, Department of Clinical GeneticsPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
13
|
Roosan D, Chok J, Baskys A, Roosan MR. PGxKnow: a pharmacogenomics educational HoloLens application of augmented reality and artificial intelligence. Pharmacogenomics 2022; 23:235-245. [PMID: 35083917 DOI: 10.2217/pgs-2021-0120] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To develop and assess an augmented reality tool for pharmacogenomics (PGx) education based on artificial intelligence. Materials & methods: A HoloLens application was developed using feedback from three clinical PGx-trained pharmacists. 15 Participants independently reviewed the application and assessed usability using the system usability scale (SUS). Results & conclusion: Eighteen different frames were developed. Each video module was 2-3 min for the education. The application included textual information and 3D structures of PGx concepts. The mean SUS score for 15 participants (11 pharmacy students and four pharmacists) was 83, with a standard deviation of 6.6. Results suggest that PGxKnow has the potential to bridge the gap in PGx education, further widespread utilization of PGx and boost its impact on precision medicine.
Collapse
Affiliation(s)
- Don Roosan
- Assistant Professor, College of Pharmacy, Department of Pharmacy Practice and Administration, Western University of Health Sciences, 309 E 2nd street, Pomona, CA 91766, USA
| | - Jay Chok
- Associate Professor, Claremont Colleges, School of Applied Life Sciences, Keck Graduate Institute, Claremont, CA 91711, USA
| | - Andrius Baskys
- Professor, College of Graduate Biomedical Sciences, Western University of Health Sciences, 309 E 2nd street, Pomona, CA 91766, USA
| | - Moom R Roosan
- Assistant Professor, School of Pharmacy, Department of Pharmacy Practice, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, USA
| |
Collapse
|
14
|
Wynn J, Milo Rasouly H, Vasquez-Loarte T, Saami AM, Weiss R, Ziniel SI, Appelbaum PS, Wright Clayton E, Christensen KD, Fasel D, Green RC, Hain HS, Harr M, Hoell C, Kullo IJ, Leppig KA, Myers MF, Pacyna JE, Perez EF, Prows CA, Kulchak Rahm A, Campbell-Salome G, Sharp RR, Smith ME, Wiesner GL, Williams JL, Blout Zawatsky CL, Gharavi AG, Chung WK, Holm IA. Do research participants share genomic screening results with family members? J Genet Couns 2021; 31:447-458. [PMID: 34665896 DOI: 10.1002/jgc4.1511] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 01/25/2023]
Abstract
The public health impact of genomic screening can be enhanced by cascade testing. However, cascade testing depends on communication of results to family members. While the barriers and facilitators of family communication have been researched following clinical genetic testing, the factors impacting the dissemination of genomic screening results are unknown. Using the pragmatic Electronic Medical Records and Genomics Network-3 (eMERGE-3) study, we explored the reported sharing practices of participants who underwent genomic screening across the United States. Six eMERGE-3 sites returned genomic screening results for mostly dominant medically actionable disorders and surveyed adult participants regarding communication of results with first-degree relatives. Across the sites, 279 participants completed a 1-month and/or 6-month post-results survey. By 6 months, only 34% of the 156 respondents shared their results with all first-degree relatives and 4% did not share with any. Over a third (39%) first-degree relatives were not notified of the results. Half (53%) of participants who received their results from a genetics provider shared them with all first-degree relatives compared with 11% of participants who received their results from a non-genetics provider. The most frequent reasons for sharing were a feeling of obligation (72%) and that the information could help family members make medical decisions (72%). The most common reasons indicated for not sharing were that the family members were too young (38%), or they were not in contact (25%) or not close to them (25%). These data indicate that the professional returning the results may impact sharing patterns, suggesting that there is a need to continue to educate healthcare providers regarding approaches to facilitate sharing of genetic results within families. Finally, these data suggest that interventions to increase sharing may be universally effective regardless of the origin of the genetic result.
Collapse
Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Hila Milo Rasouly
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Tania Vasquez-Loarte
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Akilan M Saami
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robyn Weiss
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sonja I Ziniel
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavior Genetics, Columbia University Irving Medical Center, New York, NY, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kurt D Christensen
- Department of Population Medicine, Precision Medicine Translational Research (PROMoTeR) Center, Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - David Fasel
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heather S Hain
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Margaret Harr
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christin Hoell
- Center for Genetic Medicine, Northwestern University, Chicago, IL, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathleen A Leppig
- Genetic Services and Kaiser Permanente Washington Health Research Institute, Kaiser Permanente of Washington, Seattle, WA, USA
| | - Melanie F Myers
- Divisions of Human Genetics and Patient Services, Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joel E Pacyna
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA
| | - Emma F Perez
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University, Chicago, IL, USA
| | - Georgia L Wiesner
- Division of Genetic Medicine, Department of Medicine, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Ali G Gharavi
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Ciucă A, Moldovan R, Băban A. Developing genetic counselling services in an underdeveloped healthcare setting. J Community Genet 2021; 12:539-548. [PMID: 34545547 PMCID: PMC8554932 DOI: 10.1007/s12687-021-00546-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022] Open
Abstract
Genetic counselling services are well established in North America, Western Europe and Australia. In other regions, genetic counselling services are still emerging. Where this is the case, an in-depth understanding of the main stakeholders’ needs, challenges and opportunities will inform the changes and innovations required to bring genetic counselling closer to the community. The present study explored the needs and challenges of patients, family members and professionals with a view to setting up a cancer genetic counselling service in Romania. In order to get a comprehensive outlook, key stakeholders were interviewed using data source triangulation method. Thirty-four semi-structured interviews were conducted (13 patients, 11 family members and 10 professionals). Thematic analysis was used to explore and identify needs, barriers and opportunities in emerging cancer genetic counselling services. Three major themes were identified: (1) the “Needs” theme mainly focuses on various types of support that participants mentioned wanting: psychosocial, peer and additional support; (2) the “Challenges” theme includes aspects related to limited access to healthcare, lack of integrated services and pressure on the families; (3) the “Hopes” theme highlights the wish for integrated healthcare and an empathic rapport with healthcare providers. Our findings highlighted the main needs, challenges and hopes the patients, family members and professionals have and provides the groundwork for setting up cancer genetic counselling services.
Collapse
Affiliation(s)
- Andrada Ciucă
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania. .,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 University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Adriana Băban
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| |
Collapse
|
16
|
Fukuzaki N, Kiyozumi Y, Higashigawa S, Horiuchi Y, Mizuguchi M, Matsubayashi H, Nishimura S, Mori K, Notsu A, Suishu I, Ohnami S, Kusuhara M, Yamaguchi K, Doorenbos AZ, Takeda Y. Sharing genetic test results of germline pathogenic variants of hereditary cancer with relatives: A single-center cross-sectional study. Jpn J Clin Oncol 2021; 51:1547-1553. [PMID: 34244736 PMCID: PMC8491536 DOI: 10.1093/jjco/hyab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to determine whether Japanese cancer patients share test results of germline pathogenic variants of hereditary cancer with their relatives. Methods This single-center cross-sectional study enrolled 21 Japanese patients who received results of germline pathogenic variants of hereditary cancer at least 6 months prior. Results All patients shared their test results with at least one relative, with the following sharing rates: 85.7% for first-degree relatives, 10% for second-degree relatives and 8.3% for third-degree relatives. Patients most commonly shared the information with their children aged >18 years (86.7%), followed by their siblings (73.6%), spouses (64.7%) and parents (54.5%). Three categories were extracted from qualitative analysis: ‘characteristics of my cancer’, ‘knowledge and caution about inheritability’ and ‘utilization of medical care.’ Conclusions The rate of test result sharing with first-degree relatives was comparable with those in Europe and the USA. Patients with germline pathogenic variants also tended to share their test results more with their children and siblings than with their parents. Informing their relatives of the results was suggestive of the motivation to influence their relatives’ health outcome and contribute to the well-being of their children and siblings.
Collapse
Affiliation(s)
- Naomi Fukuzaki
- Department of Nursing, Shizuoka Cancer Center Hospital, Shizuoka, Japan.,Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Yoshimi Kiyozumi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Yasue Horiuchi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan.,Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Maki Mizuguchi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Matsubayashi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Seiichiro Nishimura
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Breast Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Izumi Suishu
- Department of Nursing, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Sumiko Ohnami
- Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | | | | | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Yuko Takeda
- Graduate School of Health Management, Keio University, Tokyo, Japan
| |
Collapse
|
17
|
Patient and Family Preferences on Health System-Led Direct Contact for Cascade Screening. J Pers Med 2021; 11:jpm11060538. [PMID: 34200550 PMCID: PMC8230217 DOI: 10.3390/jpm11060538] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
Health benefits to relatives of people at known genetic risk for hereditary cancer syndromes is key to realizing the promise of precision medicine. We conducted a qualitative study to design a patient- and family-centered program for direct contact of relatives to recommend cascade genetic testing. We conducted two rounds of data collection using focus groups followed by individual interviews with patients with HBOC or Lynch syndrome and a separate sample of people with a family history of hereditary cancers. Results indicate that U.S.-based health system-led direct contact of relatives is acceptable to patients and families, should take a programmatic approach, include consent of relatives before proband testing, complement to existing patient-mediated disclosure, and allow for relative control of information. Our findings suggest a set of requirements for U.S.-based direct contact programs that could ultimately benefit more relatives than current approaches.
Collapse
|
18
|
Baroutsou V, Underhill-Blazey ML, Appenzeller-Herzog C, Katapodi MC. Interventions Facilitating Family Communication of Genetic Testing Results and Cascade Screening in Hereditary Breast/Ovarian Cancer or Lynch Syndrome: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13040925. [PMID: 33672149 PMCID: PMC7926393 DOI: 10.3390/cancers13040925] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Evidence-based guidelines recommend cascade genetic testing of blood relatives of known Hereditary Breast and Ovarian Cancer (HBOC) or Lynch Syndrome (LS) cases, to inform individualized cancer screening and prevention plans. The study identified interventions designed to facilitate family communication of genetic testing results and/or cancer predisposition cascade genetic testing for HBOC and LS. We conducted a systematic review and meta-analysis of randomized trials that assessed intervention efficacy for these two outcomes. Additional outcomes were also recorded and synthesized when possible. Fourteen articles met the inclusion criteria and were included in the narrative synthesis and 13 in the meta-analysis. Lack of participant blinding was the most common risk of bias. Interventions targeted HBOC (n = 5); both HBOC and LS (n = 4); LS (n = 3); or ovarian cancer (n = 2). All protocols (n = 14) included a psychoeducational and/or counseling component. Additional components were decision aids (n = 4), building communication skills (n = 4), or motivational interviewing (n = 1). The overall effect size for family communication was small (g = 0.085) and not significant (p = 0.344), while for cascade testing, it was small (g = 0.169) but significant (p = 0.014). Interventions show promise for improving cancer predisposition cascade genetic testing for HBOC and LS. Future studies should employ family-based approaches and include racially diverse samples.
Collapse
Affiliation(s)
- Vasiliki Baroutsou
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland;
| | - Meghan L. Underhill-Blazey
- School of Nursing, Wilmot Cancer Institute Hereditary Cancer Program, University of Rochester, Rochester, NY 14642, USA;
| | | | - Maria C. Katapodi
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland;
- Correspondence: ; Tel.: +41-61-207-04-30
| |
Collapse
|
19
|
Roosan D, Hwang A, Roosan MR. Pharmacogenomics cascade testing (PhaCT): a novel approach for preemptive pharmacogenomics testing to optimize medication therapy. THE PHARMACOGENOMICS JOURNAL 2021; 21:1-7. [PMID: 32843688 PMCID: PMC7840503 DOI: 10.1038/s41397-020-00182-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/18/2020] [Accepted: 08/12/2020] [Indexed: 11/08/2022]
Abstract
The implementation of pharmacogenomics (PGx) has come a long way since the dawn of utilizing pharmacogenomic data in clinical patient care. However, the potential benefits of sharing PGx results have yet to be explored. In this paper, we explore the willingness of patients to share PGx results, as well as the inclusion of family medication history in identifying potential family members for pharmacogenomics cascade testing (PhaCT). The genetic similarities in families allow for identifying potential gene variants prior to official preemptive testing. Once a candidate patient is determined, PhaCT can be initiated. PhaCT recognizes that further cascade testing throughout a family can serve to improve precision medicine. In order to make PhaCT feasible, we propose a novel shareable HIPAA-compliant informatics platform that will enable patients to manage not only their own test results and medications but also those of their family members. The informatics platform will be an external genomics system with capabilities to integrate with patients' electronic health records. Patients will be given the tools to provide information to and work with clinicians in identifying family members for PhaCT through this platform. Offering patients the tools to share PGx results with their family members for preemptive testing could be the key to empowering patients. Clinicians can utilize PhaCT to potentially improve medication adherence, which may consequently help to distribute the burden of health management between patients, family members, providers, and payers.
Collapse
Affiliation(s)
- Don Roosan
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
| | - Angela Hwang
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Moom R Roosan
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, School of Pharmacy, Irvine, CA, USA.
| |
Collapse
|
20
|
Offit K, Tkachuk KA, Stadler ZK, Walsh MF, Diaz-Zabala H, Levin JD, Steinsnyder Z, Ravichandran V, Sharaf RN, Frey MK, Lipkin SM, Robson ME, Hamilton JG, Vijai J, Mukherjee S. Cascading After Peridiagnostic Cancer Genetic Testing: An Alternative to Population-Based Screening. J Clin Oncol 2020; 38:1398-1408. [PMID: 31922925 PMCID: PMC7193752 DOI: 10.1200/jco.19.02010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Despite advances in DNA sequencing technology and expanded medical guidelines, the vast majority of individuals carrying pathogenic variants of common cancer susceptibility genes have yet to be identified. An alternative to population-wide genetic screening of healthy individuals would exploit the trend for genetic testing at the time of cancer diagnosis to guide therapy and prevention, combined with augmented familial diffusion or "cascade" of genomic risk information. METHODS Using a multiple linear regression model, we derived the time interval to detect an estimated 3.9 million individuals in the United States with a pathogenic variant in 1 of 18 cancer susceptibility genes. We analyzed the impact of the proportion of incident patients sequenced, varying observed frequencies of pathogenic germline variants in patients with cancer, differential rates of diffusion of genetic information in families, and family size. RESULTS The time to detect inherited cancer predisposing variants in the population is affected by the extent of cascade to first-, second-, and third-degree relatives (FDR, SDR, TDR, respectively), family size, prevalence of mutations in patients with cancer, and the proportion of patients with cancer sequenced. In a representative scenario, assuming a 7% prevalence of pathogenic variants across cancer types, an average family size of 3 per generation, and 15% of incident patients with cancer in the United States undergoing germline testing, the time to detect all 3.9 million individuals with pathogenic variants in 18 cancer susceptibility genes would be 46.2, 22.3, 13.6, and 9.9 years if 10%, 25%, 50%, and 70%, respectively, of all FDR, SDR, and TDR were tested for familial mutations. CONCLUSION Peridiagnostic and cascade cancer genetic testing offers an alternative strategy to achieve population-wide identification of cancer susceptibility mutations.
Collapse
Affiliation(s)
- Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Kaitlyn A. Tkachuk
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Zsofia K. Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Michael F. Walsh
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Hector Diaz-Zabala
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Jeffrey D. Levin
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Zoe Steinsnyder
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Vignesh Ravichandran
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Ravi N. Sharaf
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Melissa K. Frey
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Steven M. Lipkin
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Mark E. Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Jada G. Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Joseph Vijai
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Semanti Mukherjee
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| |
Collapse
|
21
|
Himes DO, Davis SH, Lassetter JH, Peterson NE, Clayton MF, Birmingham WC, Kinney AY. Does family communication matter? Exploring knowledge of breast cancer genetics in cancer families. J Community Genet 2019; 10:481-487. [PMID: 30877488 PMCID: PMC6754477 DOI: 10.1007/s12687-019-00413-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/28/2019] [Indexed: 12/24/2022] Open
Abstract
Knowledge of breast cancer genetics is critical for those at increased hereditary risk who must make decisions about breast cancer screening options. This descriptive study explored theory-based relationships among cognitive and emotional variables related to knowledge of breast cancer genetics in cancer families. Participants included first-degree relatives of women with breast cancer who had received genetic counseling and testing. Study participants themselves did not have breast cancer and had not received genetic counseling or testing. Data were collected by telephone interviews and surveys. Variables analyzed included numeracy, health literacy, cancer-related distress, age, education, and the reported amount of information shared by the participants' family members about genetic counseling. The multiple regression model explained 13.9% of variance in knowledge of breast cancer genetics (p = 0.03). Best fit of the multiple regression model included all variables except education. Reported amount of information shared was the only independently significant factor associated with knowledge (β = 0.28, p = 0.01). Participants who reported higher levels of information shared by a family member about information learned during a genetic counseling session also demonstrated increased knowledge about breast cancer genetics.
Collapse
Affiliation(s)
- Deborah O Himes
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA.
| | - Sarah H Davis
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Jane H Lassetter
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Neil E Peterson
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Margaret F Clayton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Wendy C Birmingham
- Department of Psychology, Brigham Young University, 1054 Spencer W. Kimball Tower, Provo, UT, 84604, USA
| | - Anita Y Kinney
- Department of Epidemiology - School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| |
Collapse
|
22
|
Turbitt E, Roberts MC, Taber JM, Waters EA, McNeel TS, Biesecker BB, Klein WMP. Genetic counseling, genetic testing, and risk perceptions for breast and colorectal cancer: Results from the 2015 National Health Interview Survey. Prev Med 2019; 123:12-19. [PMID: 30817954 PMCID: PMC7321923 DOI: 10.1016/j.ypmed.2019.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/16/2019] [Accepted: 02/23/2019] [Indexed: 11/19/2022]
Abstract
We examined what proportion of the U.S. population with no personal cancer history reported receiving either genetic counseling or genetic testing for cancer risk, and also the association of these behaviors with cancer risk perceptions. We used data from the 2015 National Health Interview Survey. Objective relative risk scores for breast (women) and colorectal (men and women) cancer risk were generated for individuals without a personal history of cancer. Participants' risk perceptions were compared with their objective relative risk. Of 12,631 women, 1.2% reported receiving genetic counseling and 0.8% genetic testing for hereditary breast cancer risk. Of 15,085 men and women, 0.8% reported receiving genetic counseling and 0.3% genetic testing for hereditary colorectal cancer risk. Higher breast cancer risk perception was associated with genetic counseling (OR: 4.31, 95%CI: 2.56, 7.26) and testing (OR: 3.56, 95%CI: 1.80, 7.03). Similarly, higher perception of colorectal cancer risk was associated with genetic counseling (OR: 5.04, 95%CI: 2.57, 9.89) and testing (OR: 5.92, 95%CI: 2.40, 14.63). A higher proportion of individuals with colorectal cancer risk perceptions concordant with their objective risk (vs. discordant) had undergone genetic counseling or testing for colorectal cancer risk. Concordant risk perceptions for breast cancer were not associated with breast cancer genetic counseling or testing. Given frequent dialogue about implementing population level programs involving genetic services for cancer risk, policy makers and investigators should consider the role of risk perceptions in the effectiveness and design of such programs and potential strategies for addressing inaccuracies in risk perceptions.
Collapse
Affiliation(s)
- Erin Turbitt
- National Human Genome Research Institute, Bethesda, MD, United States of America; University of Technology Sydney, NSW, Australia.
| | - Megan C Roberts
- National Cancer Institute, Rockville, MD, United States of America
| | | | - Erika A Waters
- Washington University School of Medicine in St. Louis, St Louis, MO, United States of America
| | - Timothy S McNeel
- Information Management Services, Inc., Calverton, MD, United States of America
| | - Barbara B Biesecker
- Research Triangle Institute, International, Washington, DC, United States of America
| | - William M P Klein
- National Human Genome Research Institute, Bethesda, MD, United States of America; National Cancer Institute, Rockville, MD, United States of America
| |
Collapse
|
23
|
Henrikson NB, Blasi PR, Fullerton SM, Grafton J, Leppig KA, Jarvik GP, Larson EB. "It would be so much easier": health system-led genetic risk notification-feasibility and acceptability of cascade screening in an integrated system. J Community Genet 2019; 10:461-470. [PMID: 30843145 PMCID: PMC6754469 DOI: 10.1007/s12687-019-00412-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/04/2019] [Accepted: 02/07/2019] [Indexed: 11/02/2022] Open
Abstract
Assess the feasibility and acceptability of health system-led genetic risk notification in a US integrated health system. We conducted semi-structured phone interviews with individuals age 40-64 years who had undergone genetic sequencing, but had not yet received their results, assessing attitudes to direct outreach to relatives. During each interview, we collected contact information for adult relatives identified as members of the same system and attempted to identify each relative in administrative data. We conducted 20 interviews. Most participants expressed support for Kaiser Permanente Washington involvement in familial risk notification. Direct outreach to relatives received the most unqualified support; outreach to the relatives' physician or interaction with the relatives' electronic medical record received more tempered support. Support was motivated by the desire to have risk communicated accurately and quickly. The most common caveat was a desire to alert relatives before the health system contacted them. Of 57 named relatives who were members of the same health system, we retrieved a single match for 40 (70.2%) based on name or birthdate. Health system involvement in familial risk notification received support in a sample of patients in a US integrated health system, and identification of relatives is feasible.
Collapse
Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| |
Collapse
|
24
|
Roberts MC, Taber JM, Klein WM. Engagement with Genetic Information and Uptake of Genetic Testing: the Role of Trust and Personal Cancer History. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:893-900. [PMID: 28105554 DOI: 10.1007/s13187-016-1160-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We used national survey data to (1) determine the extent to which individuals trust the sources from which they are most likely to receive information about cancer-related genetic tests (BRCA1/2, Lynch syndrome), (2) examine how level of trust for sources of genetic information might be related to cancer-related genetic testing uptake, and (3) determine whether key factors, such as cancer history and numeracy, moderate the latter association. We used cross-sectional data from the Health Information National Trends Survey. Our study sample included individuals who responded that they had heard or read about genetic tests (n = 1117). All analyses accounted for complex survey design. Although respondents trusted information from health professionals the most, they were significantly less likely to report hearing about genetic testing from such professionals than via television (p < 0.01). Regardless of source, higher levels of trust in the information source from which participants heard about genetic tests were associated with increased odds of genetic testing uptake, particularly among those with a personal cancer history. Numeracy was not associated with genetic testing uptake. Because health professionals were among the most trusted health information sources, they may serve as important brokers of genetic testing information for those with a personal cancer history.
Collapse
Affiliation(s)
- Megan C Roberts
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA.
| | - Jennifer M Taber
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - William M Klein
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| |
Collapse
|
25
|
Krakow M, Ratcliff CL, Hesse BW, Greenberg-Worisek AJ. Assessing Genetic Literacy Awareness and Knowledge Gaps in the US Population: Results from the Health Information National Trends Survey. Public Health Genomics 2018; 20:343-348. [PMID: 29852491 PMCID: PMC6095736 DOI: 10.1159/000489117] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Public understanding of the role of genetics in disease risk is key to appropriate disease prevention and detection. This study assessed the current extent of awareness and use of genetic testing in the US population. Additionally, the study identified characteristics of subgroups more likely to be at risk for low genetic literacy. METHODS The study used data from the National Cancer Institute's 2017 Health Information National Trends Survey, including measures of genetic testing awareness, genetic testing applications and genetic testing usage. Multivariable logistic regression models estimated associations between sociodemographics, genetic testing awareness, and genetic testing use. RESULTS Fifty-seven percent of respondents were aware of genetic tests. Testing awareness differed by age, household income, and race/ethnicity. Most participants had heard of using tests to determine personal disease risk (82.58%) or inherited disease risk in children (81.41%), but less were familiar with determining treatment (38.29%) or drug efficacy (40.76%). Among those with genetic testing awareness, actual testing uptake was low. CONCLUSIONS A large portion of the general public lacks genetic testing awareness and may benefit from educational campaigns. As precision medicine expands, increasing public awareness about genetic testing applications for disease prevention and treatment will be important to support population health.
Collapse
Affiliation(s)
- Melinda Krakow
- Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Chelsea L Ratcliff
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Bradford W Hesse
- Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | |
Collapse
|
26
|
Taber JM, Klein WMP, Lewis KL, Johnston JJ, Biesecker LG, Biesecker BB. Reactions to clinical reinterpretation of a gene variant by participants in a sequencing study. Genet Med 2017; 20:337-345. [PMID: 28771245 PMCID: PMC6611163 DOI: 10.1038/gim.2017.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 01/18/2023] Open
Abstract
PurposeAs genome science advances, people receiving personalized genetic information may receive reinterpretations of pathogenicity. Little is known about responses to adjusted results. We examined how reinterpretations might affect attitudes about genetic testing and intentions to share results with family.MethodsData were collected from high-socioeconomic-status participants (n = 58) in a genome sequencing study. Twenty-nine originally learned they were carriers of Duarte variant galactosemia, based on a variant that was reclassified as benign. Positive testers (n = 19) had a newly identified causative variant and remained carriers. Negative testers (n = 10) learned they were no longer carriers. Twenty-nine controls were carriers for a disease of comparable severity with no reclassification. Participants completed baseline, immediate, and 3-month follow-up surveys.ResultsApproximately 80% of participants demonstrated complete or partially accurate recall of their results and reported positive or neutral reactions to their result and about genetic information more generally. Positive testers reported lower intentions to share the change in their result with family. Controls reported the lowest intentions to learn future results. There were no significant group differences or changes over time in perceived ambiguity or negative emotions.ConclusionThe results suggest that high-socioeconomic-status participants understand reinterpretations conferring a neutral change or a change from carrier to noncarrier status. Participants' responses to changes in carrier results for a low-risk condition indicated minimal adverse effects.
Collapse
Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Katie L Lewis
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | | | | | | |
Collapse
|
27
|
Healey E, Taylor N, Greening S, Wakefield CE, Warwick L, Williams R, Tucker K. Quantifying family dissemination and identifying barriers to communication of risk information in Australian BRCA families. Genet Med 2017; 19:1323-1331. [DOI: 10.1038/gim.2017.52] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/13/2017] [Indexed: 12/11/2022] Open
|
28
|
Hamilton JG, Abdiwahab E, Edwards HM, Fang ML, Jdayani A, Breslau ES. Primary care providers' cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda. J Gen Intern Med 2017; 32:315-324. [PMID: 27995427 PMCID: PMC5331015 DOI: 10.1007/s11606-016-3943-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/15/2016] [Accepted: 11/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps. METHODS We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs. RESULTS We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing. DISCUSSION This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patient-provider communication about genetic risk and genetic testing.
Collapse
Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ekland Abdiwahab
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Min-Lin Fang
- UCSF Library, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Jdayani
- Torrance Health IPA, Torrance Memorial Health System, Torrance, CA, USA
| | - Erica S Breslau
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
29
|
Elrick A, Ashida S, Ivanovich J, Lyons S, Biesecker BB, Goodman MS, Kaphingst KA. Psychosocial and Clinical Factors Associated with Family Communication of Cancer Genetic Test Results among Women Diagnosed with Breast Cancer at a Young Age. J Genet Couns 2016; 26:173-181. [PMID: 27422778 DOI: 10.1007/s10897-016-9995-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
Genetic test results have medical implications beyond the patient that extend to biological family members. We examined psychosocial and clinical factors associated with communication of genetic test results within families. Women (N = 1080) diagnosed with breast cancer at age 40 or younger completed an online survey; 920 women that reported prior cancer genetic testing were included in analysis. We examined the proportion of immediate family members to whom they communicated genetic test results, and built multivariable regression models to examine clinical and psychosocial variables associated with the proportion score. Participants were most likely to communicate test results to their mother (83 %) and least likely to their son (45 %). Participants who carried a BRCA mutation (OR = 1.34; 95 % CI = 1.06, 1.70), had higher interest in genomic information (OR = 1.55; 95 % CI = 1.26, 1.91) and lower genetic worry (OR = 0.91; 95 % CI = 0.86, 0.96) communicated genetic test results to a greater proportion of their immediate family members. Participants with a BRCA1/2 mutation shared their genetic test results with more male family members (OR = 1.72; 95 % CI = 1.02, 2.89). Our findings suggest that patients with high worry about genetic risks, low interest in genomic information, or receive a negative genetic test result will likely need additional support to encourage family communication.
Collapse
Affiliation(s)
- Ashley Elrick
- Department of Communication, University of Utah, 255 Central Campus Drive, LNCO, Salt Lake City, UT, 84112, USA.
| | - Sato Ashida
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jennifer Ivanovich
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Lyons
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, 255 Central Campus Drive, LNCO, Salt Lake City, UT, 84112, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|