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; 15:387-400. [PMID: 39046652 PMCID: PMC11410744 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
|
Klitzman R, Bezborodko E, Chung WK, Appelbaum PS. Parents' views of benefits and limitations of receiving genetic diagnoses for their offspring. Child Care Health Dev 2024; 50:e13212. [PMID: 38097387 PMCID: PMC10841588 DOI: 10.1111/cch.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/16/2023] [Accepted: 11/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Individuals with autism with intellectual disabilities (ID) are increasingly undergoing genetic testing, posing questions of how parents view/respond to such results. METHODS Twenty-eight parents whose offspring had received genetic diagnoses of de novo pathogenic variants associated with autism were interviewed. RESULTS Genetic diagnoses parents receive concerning their offspring's autism/intellectual disabilities can be 'double-edged' in several ways, having advantages, but also certain disadvantages and limitations. Benefits were medical/scientific (e.g., ending diagnostic odysseys and potentially contributing to research), emotional (e.g., relief, peace of mind and less self-blame), cognitive, social (e.g., validation and confirmation with others - it's 'not just in our head') and financial (e.g., estate planning), now and in the future (e.g., preparing for possible future symptoms, development and availability of treatment and setting realistic expectations). Limitations included a lack of medical treatments related to the genetic diagnosis, a sense of finality and heightened uncertainties which can increase anxieties (e.g., concerning additional symptoms associated with genetic diagnoses and offspring's ability to live independently in the future). Overall, parents were glad to receive the results, seeing the pros outweighing the cons. Parents responded to these tensions in various ways, having mixed feelings, recognizing the trade-offs and/or focusing on their offspring's present needs. Factors such as age of offspring at receipt of genetic diagnosis, parent's scientific background and prior views and degrees of self-blame affected these responses. CONCLUSIONS These data, the first to examine how parents perceive genetic diagnoses received for offspring with autism and ID through whole exome/whole genome sequencing, highlight practical medical and psychological benefits as well as limitations. These findings thus have important implications for future education, engagement of families and research. Providers should be aware of these issues, to inform and assist families, who are considering such testing, about these potential pros and cons and responses.
Collapse
Affiliation(s)
- Robert Klitzman
- Professor of Psychiatry and Director of the Masters of Bioethics Program; Department of Psychiatry; Columbia University; New York, NY, USA
| | - Ekaterina Bezborodko
- Research Associate; Department of Law Ethics and Psychiatry; Columbia University; New York, NY, USA
| | - Wendy K. Chung
- Chief, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School Boston, MA, USA
| | - Paul S. Appelbaum
- Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law; Center for Law, Ethics and Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| |
Collapse
|
3
|
Tiller JM, Stott A, Finlay K, Boughtwood T, Madelli EO, Horton A, Winship I, Nowak K, Otlowski M. Direct notification by health professionals of relatives at-risk of genetic conditions (with patient consent): views of the Australian public. Eur J Hum Genet 2024; 32:98-108. [PMID: 37280361 PMCID: PMC10242214 DOI: 10.1038/s41431-023-01395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/27/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
Genetic risk information for medically actionable conditions has relevance for patients' blood relatives. However, cascade testing uptake in at-risk families is <50%, and the burden of contacting relatives is a significant barrier to dissemination of risk information. Health professionals (HPs) could notify at-risk relatives directly, with patients' consent. This practice is supported by international literature, including strong public support. However, there is little exploration of the Australian public's views about this issue. We surveyed Australian adults using a consumer research company. Respondents were provided a hypothetical scenario and asked about views and preferences regarding direct contact by HPs. 1030 members of the public responded, with median age 45 y and 51% female. The majority would want to be told about genetic risk for conditions that can be prevented/treated early (85%) and contacted directly by a HP (68%). Most preferred a letter that included specific information about the genetic condition in the family (67%) and had no privacy concerns about HPs sending a letter using contact details provided by a relative (85%). A minority (< 5%) had significant privacy concerns, mostly about use of personal contact information. Concerns included ensuring information was not shared with third parties. Almost 50% would prefer that a family member contacted them before the letter was sent, while about half did not prefer this or were unsure. The Australian public supports (and prefers) direct notification of relatives at risk of medically actionable genetic conditions. Guidelines would assist with clarifying clinicians' discretion in this area.
Collapse
Affiliation(s)
- Jane M Tiller
- Australian Genomics, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Ami Stott
- Australian Genomics, Parkville, VIC, Australia
| | - Keri Finlay
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ari Horton
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen Nowak
- Office of Population Health Genomics, WA Department of Health, East Perth, WA, Australia
| | - Margaret Otlowski
- Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| |
Collapse
|
4
|
Cragun DL, Hunt PP, Dean M, Weidner A, Shields AK, Tezak A, Pal T. Applying the framework for developing and evaluating complex interventions to increase family communication about hereditary cancer. PEC INNOVATION 2023; 2:100133. [PMID: 37214492 PMCID: PMC10194404 DOI: 10.1016/j.pecinn.2023.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 05/24/2023]
Abstract
Objective Evaluate an intervention to increase family communication (FC) of positive hereditary cancer test results using the Framework for Developing and Evaluating Complex Interventions (FDECI). Methods We developed 'programme theory' during the FDECI development phase by aligning intervention components with behavior change techniques (BCTs) and theoretical factors expected to improve FC. During the feasibility phase, we obtained feedback from 12 stakeholder interviews. Results Intervention components aligned with a total of 14 unique BCTs for which prior evidence links the BCT to theoretical factors that influence behavior change. Constructive stakeholder feedback included: more information desired, rewording to support autonomy by highlighting options, and improvements to navigation, visuals, and audio. Positive comments included: comprehensiveness of materials, modeling of conversations, and usefulness of the materials for helping a person prepare to share positive test results. Conclusion The first FDECI phases were helpful for improving the intervention and planning our ongoing effectiveness and future implementation phases. Innovation Our application of the FDECI is novel, including plans to test our 'programme theory' using coincidence analysis (CNA) to determine who accesses which intervention materials, how utilizing certain materials impact the aligned theoretical factors, and whether these in turn make a difference in the behavioral outcome.
Collapse
Affiliation(s)
- Deborah L. Cragun
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Paige Phillips Hunt
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Marleah Dean
- University of South Florida, Department of Communication, Tampa, FL; Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, FL, United States of America
- Moffitt Cancer Center, Health Outcomes & Behavior Program, Tampa, FL, United States of America
| | - Anne Weidner
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Andrea K. Shields
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Ann Tezak
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Tuya Pal
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| |
Collapse
|
5
|
Zhao J, Guan Y, McBride CM. A systematic review of theory-informed strategies used in interventions fostering family genetic risk communication. PATIENT EDUCATION AND COUNSELING 2022; 105:1953-1962. [PMID: 35304074 PMCID: PMC9203975 DOI: 10.1016/j.pec.2022.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Inherited risk is a family issue. Identifying family members who carry a pathogenic genetic variant that increases risk of cancers and other chronic diseases can be lifesaving for those affected. OBJECTIVE The research questions are: (1) which family communication frameworks have been applied, (2) how do intervention strategies employed map to these theories, and (3) to what extent were families receptive to these strategies and communication increased? METHODS Manuscripts published between January 2010 and August 2020 were searched in three databases: PubMed, PsycINFO, and Web of Science. RESULTS Nine intervention trials were identified. All interventions were evaluated in clinical genetic counseling contexts using at least one individual-level strategy (e.g. increase knowledge). Only three focused on dyadic conversations such as preparing for relatives' information needs. CONCLUSIONS This systematic review posed the question whether theoretically based approaches have been applied to foster family genetic risk communication. Greater attention needs to be paid to the utilization of dyadic level and family system level theories to guide intervention developments. PRACTICAL IMPLICATIONS We conclude by calling for accelerating and broadening the development of interventions to enable family communication about inherited risk that are theory-based, incorporate family-systems thinking, and are conducted outside of specialty clinic settings.
Collapse
Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
| |
Collapse
|
6
|
Cragun D, Beckstead J, Farmer M, Hooker G, Dean M, Matloff E, Reid S, Tezak A, Weidner A, Whisenant JG, Pal T. IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results. BMC Cancer 2021; 21:1099. [PMID: 34645413 PMCID: PMC8513202 DOI: 10.1186/s12885-021-08822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectiveness-implementation trial to simultaneously evaluate the effectiveness of two interventions for individuals with inherited cancer predisposition focused on: 1) increasing family communication (FC) of genetic test results; and 2) improving engagement with guideline-based cancer risk management (CRM). METHODS This prospective study will recruit a racially, geographically, and socioeconomically diverse population of individuals with a documented pathogenic/likely pathogenic (P/LP) variant in an inherited cancer gene. Eligible participants will be asked to complete an initial trial survey and randomly assigned to one of three arms: A) GeneSHARE, a website designed to increase FC of genetic test results; B) My Gene Counsel's Living Lab Report, a digital tool designed to improve understanding of genetic test results and next steps, including CRM guidelines; or C) a control arm in which participants continue receiving standard care. Follow-up surveys will be conducted at 1, 3, and 12 months following randomization. These surveys include single-item measures, scales, and indices related to: 1) FC and CRM behaviors and behavioral factors following the COM-B theoretical framework (i.e., capability, opportunity, and motivation); 2) implementation outcomes (i.e., acceptability, appropriateness, exposure, and reach); and 3) other contextual factors (i.e., sociodemographic and clinical factors, and uncertainty, distress, and positive aspects of genetic test results). The primary outcomes are an increase in FC of genetic test results (Arm A) and improved engagement with guideline-based CRM without overtreatment or undertreatment (Arm B) by the 12-month follow-up survey. DISCUSSION Our interventions are designed to shift the paradigm by which individuals with P/LP variants in inherited cancer genes are provided with information to enhance FC of genetic test results and engagement with guideline-based CRM. The information gathered through evaluating the effectiveness and implementation of these real-world approaches is needed to modify and scale up adaptive, stepped interventions that have the potential to maximize FC and CRM. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (NCT04763915, date registered: February 21, 2021). PROTOCOL VERSION September 17th, 2021 Amendment Number 04.
Collapse
Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Meagan Farmer
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Gillian Hooker
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 East Fowler Avenue, CIS 3043, Tampa, FL, 33620, USA
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ellen Matloff
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Sonya Reid
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Ann Tezak
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Anne Weidner
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Jennifer G Whisenant
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA.
| |
Collapse
|
7
|
Development of a Secure Website to Facilitate Information Sharing in Families at High Risk of Bowel Cancer-The Familyweb Study. Cancers (Basel) 2021; 13:cancers13102404. [PMID: 34065728 PMCID: PMC8155923 DOI: 10.3390/cancers13102404] [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] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Families with an inherited high risk of bowel cancer may struggle to share information about their diagnosis. This means that relatives are not always aware of their increased risk of cancer or able to access screening for the early detection of cancer. Through this study, we aimed to help such families by creating a website where patients could share confidential information with their relatives securely online. Following a survey and telephone interviews with affected individuals, the content of the website was developed to suit the needs of families. Website function was tested with patients to check feasibility and acceptability. Most participants wanted more information to support their adaptation to the diagnosis and help inform their relatives. This study demonstrates how health professionals can improve access to genetic testing and cancer screening in families at high risk of cancer, thus reducing morbidity and mortality. Abstract Individuals with pathogenic variants in genes predisposing to bowel cancer are encouraged to share this information within their families. Close relatives at 50% risk can have access to bowel cancer surveillance. However, many relatives remain unaware of their vulnerability or have insufficient information. We investigated the feasibility and acceptability of using a secure website to support information sharing within families at high risk of bowel cancer. Patients (n = 286) answered an anonymous cross-sectional survey, with 14 participating in telephone interviews. They reported that the diagnosis had a profound effect on them and their family relationships, and consequently desired more support from health professionals. Website content was created in response to the preferences of survey and interview participants. Reactions to the website from 12 volunteers were captured through remote usability testing to guide further refinement of the website. Participants welcomed the opportunity to store and share personal information via the website and wanted more information and help informing their relatives about the diagnosis. Important website topics were: healthy lifestyle; genetic testing; and how to talk to children about the diagnosis. A website providing online access to confidential documents was both feasible and acceptable and could translate into increased uptake of cancer surveillance, resulting in lower morbidity and mortality in these families.
Collapse
|
8
|
Oncologists' perspectives of telephone genetic counseling to facilitate germline BRCA1/2 testing for their patients with high-grade serous ovarian cancer. J Community Genet 2021; 12:449-457. [PMID: 33956303 DOI: 10.1007/s12687-021-00530-7] [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: 09/23/2020] [Accepted: 04/20/2021] [Indexed: 10/21/2022] Open
Abstract
Poly ADP ribose polymerase (PARP) inhibitors offer a survival advantage to women with high-grade serous ovarian cancer who have a germline BRCA1/2 pathogenic variant (PV). Yet, rates of genetic testing among this population have remained persistently low. A national, centralized telephone genetic counseling service was established in January 2016 in Australia to improve access to genetic services and facilitate BRCA1/2 testing for this population to inform treatment. Medical oncologists can refer their patients with high-grade serous ovarian cancer to this service for genetic testing. This study aimed to explore oncologists' experiences of using this telephone genetic counseling service for their patients with high-grade serous ovarian cancer. A qualitative approach using semi-structured telephone interviews was undertaken with Australian oncologists who had referred patients to the telephone genetic counseling service. Sixteen oncologists participated and described referring patients to the telephone genetic counseling service due to the timeliness of obtaining a genetic counseling appointment and BRCA1/2 test results. They also reported this service offered convenience for patients living in regional or rural areas who then did not have to travel for an appointment with a clinical genetics service. Many oncologists noted the importance of in-person genetic counseling for patients who received positive BRCA1/2 results. Areas for improvement identified by the oncologists related to communication issues between the service and the patient. Overall, findings suggest that oncologists perceived telephone genetic counseling as an acceptable and useful healthcare service for patients with high-grade serous ovarian cancer. Moreover, they perceived telephone genetic counseling to be efficient, delivering convenient genetic counseling to patients.
Collapse
|
9
|
Haas CB, Scrol A, Jujjavarapu C, Jarvik GP, Henrikson NB. Usefulness of mobile apps for communication of genetic test results to at-risk family members in a U.S. integrated health system: a qualitative approach from user-testing. HEALTH POLICY AND TECHNOLOGY 2021; 10. [PMID: 34040952 DOI: 10.1016/j.hlpt.2021.100511] [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] [Indexed: 12/20/2022]
Abstract
Objective To assess the usefulness a mobile based application to send genetic test results to at-risk family members in a U.S. integrated health system. Methods We conducted semi-structured in-person interviews with members of Kaiser Permanente Washington who had enrolled in a prospective study and received genetic test results. Participants were given the task to use the app and comment on the experience. The moderator asked participants to share perspectives on the usefulness of a mobile based app and their lived experiences of sharing their test results with family members. Results Fourteen study participants who had undergone genetic testing were interviewed. Four primary themes emerged as relevant to the use of mobile-based apps as a tool for communicating genetic test results to at-risk family members: (i) Participants felt a sense of obligation to share positive test results with relatives; (ii) Participants felt that the advantages of using email were similar to those of the app; (iii) Participants felt that younger individuals would be more comfortable with an app; and, (iv) Participants felt they could use the app independently and in their own time. Conclusion A mobile based app could be used as a tool to improve cascade screening for pathogenic/likely pathogenic test results. The benefits of such a tool are likely greatest among relatives still at the stage of family planning, as well as among family members with strained relationships. There would be minimal burden on the system to offer a mobile based app as a tool.
Collapse
Affiliation(s)
- Cameron B Haas
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Aaron Scrol
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Chethan Jujjavarapu
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington School of Medicine, Seattle, WA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| |
Collapse
|
10
|
Di Pietro ML, Zaçe D, Orfino A, Di Raimo FR, Poscia A, de Matteis E, Turchetti D, Godino L, Bertonazzi B, Franiuk M, Bruzzone C, Varesco L, Lucci-Cordisco E, Genuardi M. Intrafamilial communication of hereditary breast and ovarian cancer genetic information in Italian women: towards a personalised approach. Eur J Hum Genet 2021; 29:250-261. [PMID: 32929237 PMCID: PMC7868365 DOI: 10.1038/s41431-020-00723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
Genomic testing expansion is accompanied by an increasing need for genetic counselling and intrafamilial communication. Genetic counselling can play an important role in facilitating intrafamilial communication and relationships. We conducted a cross-sectional, multicenter study including 252 Italian women, using a questionnaire divided in two sections, the first one to be filled after the pre-test counselling and the second after receiving BRCA test results. We assessed the factors influencing intrafamilial disclosure of genetic information for hereditary breast and ovarian cancer, family members with whom probands are more prone to share genetic information, and the perceived understanding of information received by counselees during genetic counselling. Women were accompanied to the counselling more often by their husband/partner. Among those with a positive BRCA test result, 49% intended to communicate it to their offspring and 27% to their husband/partner. Younger women, those living with their husband/partner, and those who described family communication as open/profound and spontaneous/sincere had a higher probability of being accompanied during genetic counselling and discuss about it with relatives. Spontaneous/sincere or open/profound family communication and joyful/happy familial relationships were associated with the decision to undergo genetic testing as a responsibility towards relatives. Women had a good understanding of counselling contents (mean score 9.27 in a scale 1-10). Genetic counselling providers should consider that genetic information disclosure does not depend only on the clarity of the information provided, but also on pre-existing intrafamilial communication and relationships, family structure and marital status, indicating the need for a personalised approach accounting for these factors.
Collapse
Affiliation(s)
- Maria Luisa Di Pietro
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Drieda Zaçe
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Alessia Orfino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Romana Di Raimo
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Poscia
- UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases-Department of Prevention-Local Health Authority (ASUR-AV2), Jesi, Italy
| | | | - Daniela Turchetti
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Lea Godino
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Benedetta Bertonazzi
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Marzena Franiuk
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carla Bruzzone
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Liliana Varesco
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuela Lucci-Cordisco
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genuardi
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
11
|
Nurmi SM, Halkoaho A, Moilanen J, Remes AM, Solje E. The ethical implications of genetic testing in neurodegenerative diseases: A systematic review. Scand J Caring Sci 2020; 35:1057-1074. [PMID: 33210792 DOI: 10.1111/scs.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Availability of genetic testing in neurodegenerative disorders has developed rapidly. This growing ability is providing specific genetic information to individuals and, in turn, their families, raising ethical concerns. However, family members' perspective is a seldom-studied phenomenon. AIM The aim of this systematic review was to describe the ethical aspect of genetic testing in neurodegenerative diseases from the perspective of at-risk family members. METHOD A systematic review of data was performed in accordance with the PRISMA statement. The data search was conducted using the CINAHL, PubMed and Scopus databases to identify original peer-reviewed studies published between January 2009 and April 2019. A total of 24 articles were selected. The data were analysed using inductive content analysis. FINDINGS On the basis of the analysis, four central ethical implications were identified: (i) decision-making in genetic testing as a dilemma: balance between autonomy and responsibility, (ii) the individual's right to make a voluntary and informed decision for genetic testing, (iii) conflicting emotions after knowing one's genetic status and (iv) privacy and confidentiality of genetic information: the fear of genetic discrimination and stigma. CONCLUSIONS The findings of this review increase understanding about the central ethical implications of genetic testing in neurodegenerative diseases from the perspective of family members, and identify and underline outstanding needs for further research.
Collapse
Affiliation(s)
| | - Arja Halkoaho
- Tampere University of Applied Sciences, Tampere, Finland
| | - Jukka Moilanen
- Department of Clinical Genetics, Oulu University Hospital, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu and Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
12
|
Cragun D, Weidner A, Tezak A, Clouse K, Pal T. Family communication of genetic test results among women with inherited breast cancer genes. J Genet Couns 2020; 30:701-709. [PMID: 33174380 DOI: 10.1002/jgc4.1356] [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: 03/28/2019] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023]
Abstract
Identification of inherited breast cancer may guide care. These benefits can be amplified through communication of genetic test results with at-risk family members and subsequent family testing (FT). Females with a pathogenic/likely pathogenic (P/LP) variant in BRCA1/2, PALB2, CHEK2, and/or ATM were surveyed about family communication (FC) of genetic test results and FT. Comparisons were made across genes. The 235 participants with P/LP variants (186 BRCA1/2, 28 PALB2, 15 CHEK2, and 6 ATM) had a median age of 54 and most were non-Hispanic whites (89%) with a prior breast cancer diagnosis (61%). When controlling for other variables, FC was higher among younger participants (p<.0001), those with high FC self-efficacy (p=.019), and those with P/LP variants in BRCA1/2 compared to PALB2 (p =.040) and ATM/CHEK2 (p =.032). Higher rates of FC and FT were also observed among female relatives and relatives of closer kinship. Overall 94% of participants would find one or more resources helpful with FC and 70% reported using FC resources when telling family members about their genetic test result. The three most commonly used resources included the following: (a) a family sharing letter (38%); (b) printed materials (30%); and (c) web-based information (23%). Among the 86% who spoke with a genetic counselor (GC), 93% were given at least one FC resource and the three most common resources GCs provided to participants overlapped with the resources participants would find helpful and those that were used. Our results suggest lower FC and FT rates among women with P/LP variants in genes other than BRCA1/2, the reasons for which should be evaluated in future studies. As more data to refine cancer risks and management are generated across these other inherited breast cancer genes, strategies to improve FC and FT are needed to amplify the benefits of genetic testing.
Collapse
Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anne Weidner
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
13
|
Special issues raised by evolving areas of clinical research. ETHICAL CONSIDERATIONS WHEN PREPARING A CLINICAL RESEARCH PROTOCOL 2020. [PMCID: PMC7329119 DOI: 10.1016/b978-0-12-386935-7.00014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Each study presents its own set of ethical considerations. Certain kinds of ethical issues are inherent in particular areas of clinical research, regardless of specific ethical questions associated with a specific study. In this chapter, some of the most common special areas of clinical research are presented, highlighting the ethical issues most frequently associated with each.
Collapse
|
14
|
van den Heuvel LM, Hoedemaekers YM, Baas AF, van Tintelen JP, Smets EMA, Christiaans I. A tailored approach towards informing relatives at risk of inherited cardiac conditions: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e025660. [PMID: 31289060 PMCID: PMC6615798 DOI: 10.1136/bmjopen-2018-025660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In current practice, probands are asked to inform relatives about the possibility of predictive DNA testing when a pathogenic variant causing an inherited cardiac condition (ICC) is identified. Previous research on the uptake of genetic counselling and predictive DNA testing in relatives suggests that not all relatives are sufficiently informed. We developed a randomised controlled trial to evaluate the effectiveness of a tailored approach in which probands decide together with the genetic counsellor which relatives they inform themselves and which relatives they prefer to have informed by the genetic counsellor. Here, we present the study protocol of this randomised controlled trial. METHODS A multicentre randomised controlled trial with parallel-group design will be conducted in which an intervention group receiving the tailored approach will be compared with a control group receiving usual care. Adult probands diagnosed with an ICC in whom a likely pathogenic or pathogenic variant is identified will be randomly assigned to the intervention or control group (total sample: n=85 probands). Primary outcomes are uptake of genetic counselling and predictive DNA testing by relatives (total sample: n=340 relatives). Secondary outcomes are appreciation of the approach used and impact on familial and psychological functioning, which will be assessed using questionnaires. Relatives who attend genetic counselling will be asked to fill out a questionnaire as well. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethical Committee of the Amsterdam University Medical Centres (MEC 2017-145), the Netherlands. All participants will provide informed consent prior to participation in the study. Results of the study on primary and secondary outcome measures will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NTR6657; Pre-results.
Collapse
Affiliation(s)
- Lieke M van den Heuvel
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Yvonne M Hoedemaekers
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Peter van Tintelen
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Witt K, Stümpel J, Woopen C. Caregiver burden and the medical ethos. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:383-391. [PMID: 28204949 DOI: 10.1007/s11019-017-9757-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Are physicians sometimes morally required to ease caregiver burden? In our paper we defend an affirmative answer to this question. First, we examine the well-established principle that medical care should be centered on the patient. We argue that although this principle seems to give physicians some leeway to lessen caregivers' suffering, it is very restrictive when spelled out precisely. Based on a critical analysis of existing cases for transcending patient-centeredness we then go on to argue that the medical ethos should indeed contain a rule requiring physicians to alleviate caregiver burden under certain circumstances. Finally, we apply our findings to deep brain stimulation (DBS) for Parkinson's disease. We present empirical data from a recent study of DBS indicating that spousal caregivers of Parkinson patients treated with DBS are sometimes deeply troubled by the effects of the therapy and discuss what moral obligations the treating physicians may have in such cases.
Collapse
Affiliation(s)
- Karsten Witt
- Institut für Philosophie, Universität Duisburg-Essen, Universitätsstr. 12, 45141, Essen, Germany.
| | - Johanne Stümpel
- Forschungsstelle Ethik, Uniklinik Köln, Universitätsstr. 91, 50931, Köln, Germany
| | - Christiane Woopen
- Forschungsstelle Ethik, Uniklinik Köln, Universitätsstr. 91, 50931, Köln, Germany
| |
Collapse
|
16
|
Chopra I, Kelly KM. Cancer Risk Information Sharing: The Experience of Individuals Receiving Genetic Counseling for BRCA1/2 Mutations. JOURNAL OF HEALTH COMMUNICATION 2017; 22:143-152. [PMID: 28112991 PMCID: PMC5586537 DOI: 10.1080/10810730.2016.1258743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Genetic counseling and testing for familial cancer is a unique context for the communication of risk information in the family. This study utilized a theoretical framework based on the family systems perspective to understand intrafamilial cancer risk communication patterns in the Ashkenazi Jewish population. Individuals (n = 120) at an elevated risk for BRCA1/2 mutations were included. Change in communication patterns over time was assessed using McNemar tests. Associations with communication patterns were assessed with multivariable logistic regression. Overall, the proportion of participants encouraged by others significantly (p < .001) increased from before to after genetic counseling. A higher proportion of participants were encouraged by female family members compared with male family members. Participants who were older, had no personal history of cancer, and had a higher cancer risk perception were more likely to be encouraged by others for genetic testing. Participant's intent to encourage family members for genetic testing from before counseling to after receipt of genetic test results decreased by 16.7%. Participants who had no personal history of cancer and had informative test results for a BRCA1/2 mutation were more likely to encourage other family members for genetic testing. In addition, qualitative findings suggested that closeness among family members, concern for family, especially future generations, and cognizance about cancer risk facilitate information sharing and encouragement for genetic testing. Our findings indicate that intrafamilial cancer risk communication varies with the structure of family relationships and that genetic counseling can play an important role in improving intrafamilial cancer risk communication.
Collapse
Affiliation(s)
- Ishveen Chopra
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, Robert C. Byrd Health Sciences Center, West Viginia University, Morgantown, West Virginia, USA
| | - Kimberly M. Kelly
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, Robert C. Byrd Health Sciences Center, West Viginia University, Morgantown, West Virginia, USA
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
17
|
Forbes Shepherd R, Browne TK, Warwick L. A Relational Approach to Genetic Counseling for Hereditary Breast and Ovarian Cancer. J Genet Couns 2016; 26:283-299. [PMID: 27761849 DOI: 10.1007/s10897-016-0022-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
Abstract
Ethical issues arise for genetic counselors when a client fails to disclose a genetic diagnosis of hereditary disease to family: they must consider the rights of the individual client to privacy and confidentiality as well as the rights of the family to know their genetic risk. Although considerable work has addressed issues of non-disclosure from the client's perspective, there is a lack of qualitative research into how genetic counselors address this issue in practice. In this study, a qualitative approach was taken to investigate whether genetic counselors in Australia use a relational approach to encourage the disclosure of genetic information from hereditary breast and ovarian cancer (HBOC) clients among family members; and if so, how they use it. Semi-structured qualitative interviews were conducted with 16 genetic counselors from selected states across Australia. Data collection and analysis were guided by a basic iterative approach incorporating a hybrid methodology to thematic analysis. The findings provide indicative evidence of genetic counselors employing a relational approach in three escalating stages--covert, overt and authoritative--to encourage the disclosure of genetic information. The findings lend credence to the notion that genetic counselors envision a form of relational autonomy for their clients in the context of sharing genetic information, and they depart from individualistic conceptions of care/solely client-centered counseling when addressing the needs of other family members to know their genetic status.
Collapse
Affiliation(s)
- Rowan Forbes Shepherd
- Research School of Biology, Australian National University, Canberra, ACT, Australia.
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Tamara Kayali Browne
- Research School of Biology, Australian National University, Canberra, ACT, Australia.
- Centre for Applied Philosophy and Public Ethics, Charles Sturt University, Canberra, ACT, Australia.
| | - Linda Warwick
- ACT Genetic Service, ACT Health, Canberra, ACT, Australia
| |
Collapse
|
18
|
Beard CA, Amor DJ, Di Pietro L, Archibald AD. "I'm Healthy, It's Not Going To Be Me": Exploring experiences of carriers identified through a population reproductive genetic carrier screening panel in Australia. Am J Med Genet A 2016; 170:2052-9. [PMID: 27150953 DOI: 10.1002/ajmg.a.37697] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/14/2016] [Indexed: 11/06/2022]
Abstract
Advancing genetic testing technologies mean that population-based carrier screening for multiple inherited conditions is now available. As the number of genetic conditions being screened increases, there is a need for research into how people experience these screening programs. This research aimed to explore how women experience simultaneous carrier screening for three inherited conditions: cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS). A qualitative approach was adopted using in-depth semi-structured interviews to explore the experiences of ten female participants: five SMA carriers, three CF carriers, and two FXS premutation carriers. Eight participants were pregnant when offered screening by their general practitioner or obstetrician and the decision to have screening was described as straightforward. Participants reported experiencing emotional responses such as anxiety and stress while waiting for either their partner's carrier screen result (CF or SMA carriers) or the pregnancy's CVS result (FXS carrier) and sought additional information about the relevant condition during this time. Most participants were in favor of population carrier screening for these conditions, preferably prior to conception. Genetic counselors played an essential role in supporting couples after they received a carrier result given the variable consent processes undertaken when screening was offered. Further research should focus on the development of reliable online information tailored to people receiving carrier results and strategies for raising awareness of the availability of population carrier screening within the community. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Catherine A Beard
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Louisa Di Pietro
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Genetic Support Network of Victoria, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Mendes Á, Paneque M, Sousa L, Clarke A, Sequeiros J. How communication of genetic information within the family is addressed in genetic counselling: a systematic review of research evidence. Eur J Hum Genet 2016; 24:315-25. [PMID: 26264439 PMCID: PMC4755382 DOI: 10.1038/ejhg.2015.174] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/20/2015] [Accepted: 07/03/2015] [Indexed: 11/09/2022] Open
Abstract
Supporting consultands to communicate risk information with their relatives is key to obtaining the full benefits of genetic health care. To understand how health-care professionals address this issue in clinical practice and what interventions are used specifically to assist consultands in their communication of genetic information to appropriate relatives, we conducted a systematic review. Four electronic databases and four subject-specific journals were searched for papers published, in English, between January 1997 and May 2014. Of 2926 papers identified initially, 14 papers met the inclusion criteria for the review and were heterogeneous in design, setting and methods. Thematic data analysis has shown that dissemination of information within families is actively encouraged and supported by professionals. Three overarching themes emerged: (1) direct contact from genetic services: sending letters to relatives of mutation carriers; (2) professionals' encouragement of initially reluctant consultands to share relevant information with at-risk relatives and (3) assisting consultands in communicating genetic information to their at-risk relatives, which included as subthemes (i) psychoeducational guidance and (ii) written information aids. Findings suggest that professionals' practice and interventions are predicated on the need to proactively encourage family communication. We discuss this in the context of what guidance of consultands by professionals might be appropriate, as best practices to facilitate family communication, and of the limits to non-directiveness in genetic counselling.
Collapse
Affiliation(s)
- Álvaro Mendes
- i3S –Instituto de Investigação e Inovação em Saúde, and Centre for Predictive and Preventive Genetics, IBMC –Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Milena Paneque
- i3S –Instituto de Investigação e Inovação em Saúde, and Centre for Predictive and Preventive Genetics, IBMC –Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- ICBAS, University of Porto, Porto, Portugal
| | - Liliana Sousa
- CINTESIS, Center for Health Technology and Services Research, University of Aveiro, Aveiro, Portugal
| | - Angus Clarke
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Wales, UK
| | - Jorge Sequeiros
- i3S –Instituto de Investigação e Inovação em Saúde, and Centre for Predictive and Preventive Genetics, IBMC –Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- ICBAS, University of Porto, Porto, Portugal
| |
Collapse
|
20
|
Benjamin CM, Thomas LH, Skirton H, Gustafson S, Coupe J, Patch C, Belk R, Tishkovskaya S, Calzone K, Payne K. Interventions to improve patient access to and utilisation of genetic and genomic counselling services. Cochrane Database Syst Rev 2015; 2015:CD011873. [PMID: 26989348 PMCID: PMC4790801 DOI: 10.1002/14651858.cd011873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows. PRIMARY OBJECTIVE The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention;Usual or current practice; andOther active intervention. SECONDARY OBJECTIVE The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services.
Collapse
Affiliation(s)
- Caroline M Benjamin
- School of Health, University of Central Lancashire, Preston, UK
- Department of Clinical Genetics, Liverpool Women’s NHS Foundation Trust, Liverpool, UK
| | - Lois H Thomas
- School of Health, University of Central Lancashire, Preston, UK
| | - Heather Skirton
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | | | | | - Christine Patch
- Department of Clinical Genetics, Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Rachel Belk
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester, UK
| | | | - Kathleen Calzone
- Centre for Cancer Research, Genetics Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| |
Collapse
|
21
|
Lenk C, Frommeld D. Different concepts and models of information for family-relevant genetic findings: comparison and ethical analysis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:393-408. [PMID: 25894235 DOI: 10.1007/s11019-015-9638-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Genetic predispositions often concern not only individual persons, but also other family members. Advances in the development of genetic tests lead to a growing number of genetic diagnoses in medical practice and to an increasing importance of genetic counseling. In the present article, a number of ethical foundations and preconditions for this issue are discussed. Four different models for the handling of genetic information are presented and analyzed including a discussion of practical implications. The different models' ranges of content reach from a strictly autonomous position over self-governed arrangements in the practice of genetic counseling up to the involvement of official bodies and committees. The different models show a number of elements which seem to be very useful for the handling of genetic data in families from an ethical perspective. In contrast, the limitations of the standard medical attempt regarding confidentiality and personal autonomy in the context of genetic information in the family are described. Finally, recommendations for further ethical research and the development of genetic counseling in families are given.
Collapse
Affiliation(s)
- Christian Lenk
- Institute for the History, Theory and Ethics of Medicine, Ulm University, Frauensteige 6, 89075, Ulm, Germany,
| | | |
Collapse
|
22
|
Outcomes of a randomised controlled trial of a complex genetic counselling intervention to improve family communication. Eur J Hum Genet 2015; 24:356-60. [PMID: 26130486 DOI: 10.1038/ejhg.2015.122] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/08/2022] Open
Abstract
When an inherited genetic condition is diagnosed in an individual it has implications for other family members. Privacy legislation and ethical considerations can restrict health professionals from communicating directly with other family members, and so it is frequently the responsibility of the first person in a family to receive the diagnosis (the proband) to share this news. Communication of genetic information is challenging and many at-risk family members remain unaware of important information that may be relevant to their or their children's health. We conducted a randomised controlled trial in six public hospitals to assess whether a specifically designed telephone counselling intervention improved family communication about a new genetic diagnosis. Ninety-five probands/parents of probands were recruited from genetics clinics and randomised to the intervention or control group. The primary outcome measure was the difference between the proportion of at-risk relatives who contacted genetics services for information and/or genetic testing. Audit of the family genetic file after 18 months revealed that 25.6% of intervention group relatives compared with 20.9% of control group relatives made contact with genetic services (adjusted odds ratio (OR) 1.30, 95% confidence interval 0.70-2.42, P=0.40). Although no major difference was detected overall between the intervention and control groups, there was more contact in the intervention group where the genetic condition conferred a high risk to offspring (adjusted OR 24.0, 95% confidence interval 3.4-168.5, P=0.001). The increasing sophistication and scope of genetic testing makes it imperative for health professionals to consider additional ways of supporting families in communicating genetic information.
Collapse
|
23
|
George R, Kovak K, Cox SL. Aligning policy to promote cascade genetic screening for prevention and early diagnosis of heritable diseases. J Genet Couns 2015; 24:388-99. [PMID: 25577298 DOI: 10.1007/s10897-014-9805-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Cascade genetic screening is a methodology for identifying and testing close blood relatives of individuals at increased risk for heritable conditions and follows a sequential process, minimizing testing costs and the number of family members who need to be tested. It offers considerable potential for cost savings and increased awareness of heritable conditions within families. CDC-classified Tier 1 genomic applications for hereditary breast and ovarian cancer syndrome (HBOC), Lynch Syndrome (LS), and familial hypercholesterolemia (FH) are recommended for clinical use and support the use of cascade genetic screening. Most individuals are unaware of their increased risk for heritable conditions such as HBOC, LS, and FH. Consistent implementation of cascade genetic screening could significantly increase awareness and prevention of heritable conditions. Limitations to effective implementation of cascade genetic screening include: insufficient genetic risk assessment and knowledge by a majority of healthcare providers without genetics credentials; a shortage of genetic specialists, especially in rural areas; a low rate of reimbursement for comprehensive genetic counseling services; and an individual focus on prevention by clinical guidelines and insurance coverage. The family-centric approach of cascade genetic screening improves prevention and early diagnosis of heritable diseases on a population health level. Cascade genetic screening could be better supported and augmented through changes in health policy.
Collapse
Affiliation(s)
- Rani George
- Oregon Genetics Program, Oregon Health Authority, 800 NE Oregon St, Ste. 370, Portland, OR, 97232, USA,
| | | | | |
Collapse
|
24
|
Batte B, Sheldon JP, Arscott P, Huismann DJ, Salberg L, Day SM, Yashar BM. Family communication in a population at risk for hypertrophic cardiomyopathy. J Genet Couns 2014; 24:336-48. [PMID: 25304619 DOI: 10.1007/s10897-014-9774-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/09/2014] [Indexed: 01/11/2023]
Abstract
Encouraging family communication is an integral component of genetic counseling; therefore, we sought to identify factors impacting communication to family members at risk for Hypertrophic Cardiomyopathy (HCM). Participants (N = 383) completed an online survey assessing: 1) demographics (gender, genetic test results, HCM family history, and disease severity); 2) illness representations; 3) family functioning and cohesiveness; 4) coping styles; 5) comprehension of HCM autosomal dominant inheritance; and 6) communication of HCM risk information to at-risk relatives. Participants were a national sample of individuals with HCM, recruited through the Hypertrophic Cardiomyopathy Association. Data from 183 participants were analyzed using a logistic regression analysis, with family communication as a dichotomous dependent variable. We found that female gender and higher comprehension of autosomal dominant inheritance were significant predictors of participants' communication of HCM risk information to all their siblings and children. Our results suggest that utilizing interventions that promote patient comprehension (e.g., a teaching-focused model of genetic counseling) are important and may positively impact family communication within families with HCM.
Collapse
Affiliation(s)
- Brittany Batte
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA,
| | | | | | | | | | | | | |
Collapse
|