Genetics education program to help public health nurses improve their knowledge and enhance communities' genetic literacy: a pilot study

Effectiveness of Serious Games in Improving Genetic Literacy and Genetic Risk Awareness in the General Public: A Pilot Study

Background: Genomics is an integral part of medical science; however, European citizens' literacy on basic genetic concepts is still poor. The aim of this study was to evaluate the effectiveness of Serious Games (SGs) in increasing genetic literacy in laypeople and to assess the impact of SGs on participants' perceived self-efficacy (SE) in managing genetic risk implications. Materials and Methods: Two minigames and an adventure game were created, together with leaflets reporting the same information as the SGs. Sixty participants enrolled at baseline and completed a brief sociodemographic questionnaire and an ad hoc questionnaire assessing their genetic knowledge. They were assigned to the SGs group (30 subjects) or to the Leaflets group (30 subjects) by matching age and sex. Both groups had about 40 minutes to play the SGs or to read the leaflets. In the postlearning session, participants completed the same genetic knowledge questionnaires administered at baseline and five items from the Self-Efficacy Scale, whereas the SGs group also filled in the In-Game Experience Questionnaire. Results and Conclusion: Results showed that learning genetic concepts through SGs was comparable to learning through leaflets. Playing SGs was also associated with poor feelings of frustration or annoyance, good engagement in the game challenges and contents, and positive feelings, particularly in subjects under 30 years. Participants perceiving SE increased significantly in both Leaflets and SGs groups, but the effect was higher for SGs players. SGs have the potential to increase genetic literacy in the public by making the learning process more engaging, pleasant and by enhancing SE.

Future-proofing genomic data and consent management: a comprehensive review of technology innovations

Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.

Barriers to and Facilitators of Implementing Guidelines for Detecting Familial Hypercholesterolaemia in Australia

BACKGROUND

Familial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia.

METHODS

Four, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes.

RESULTS

There were 28 workshop attendees across four groups (n=6-8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A "lack of care pathways" and "upskilling clinicians in identifying and diagnosing FH" were the most interconnected barriers and facilitators for the detection of FH.

CONCLUSIONS

The relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice.

Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022)

In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.

A qualitative reflexive thematic analysis into the experiences of being identified with a BRCA1/2 gene alteration: "So many little, little traumas could have been avoided"

Background

BRCA1/2 alterations increase females’ lifetime breast cancer risk to 40 – 90%, ovarian cancer to 10 – 60%, and males’ lifetime prostate cancer risk to ~ 10 – 25%. Psychosocial issues such as heightened distress can, therefore, occur in this population. This study aimed to explore the subjective experiences and needs of the BRCA1/2 alteration population in navigating cancer risk reduction measures.

Method

This study aimed to explore the experiences and identify the needs of 18 BRCA1/2 alteration carriers, recruited through strategic sampling. A public and patient panel (N = 6) collaborated on study development. Data were analysed using reflexive thematic analysis.

Results

Two themes were identified: (i) Healthcare Services as a Burden to Navigate, and (ii) Burden Experienced Through Interactions with Healthcare Professionals. Results indicated uncertainty regarding care pathways, alongside a lack of relevant information. Participants felt unsupported by healthcare professionals, and as though healthcare professionals often perceive them as a burden.

Conclusions

These findings suggest that the quality of interactions in healthcare systems are of relevance to the BRCA1/2 alteration population, and that uncertainty surrounding access to services and information is prevalent. The establishment of specialist hereditary cancer clinics could reduce such burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08372-w.

The Development of Education of Public Health Nurses for Applying Genomics in Preventive Health Care

Genetics and genomics have become one of the most important development areas in healthcare. For this reason, it is essential that nursing professionals take their role to offer their skills in implementing genomics in health promotion. The education of public health nurses is taking vital steps in training the health promoters who are able to take the genome-based knowledge into account in precision healthcare. Tampere University of Applied Sciences managed to integrate genomics into the studies of public health nursing. This article describes the process of development and lays emphasis on the importance of genomic education of public health nurses.

Applying implementation science to improve care for familial hypercholesterolemia

PURPOSE OF REVIEW

Improving care of individuals with familial hypercholesteremia (FH) is reliant on the synthesis of evidence-based guidelines and their subsequent implementation into clinical care. This review describes implementation strategies, defined as methods to improve translation of evidence into FH care, that have been mapped to strategies from the Expert Recommendations for Implementing Change (ERIC) compilation.

RECENT FINDINGS

A search using the term 'familial hypercholesterolemia' returned 1350 articles from November 2018 to July 2021. Among these, there were 153 articles related to improving FH care; 1156 were excluded and the remaining 37 were mapped to the ERIC compilation of strategies: assess for readiness and identify barriers and facilitators [9], develop and organize quality monitoring systems [14], create new clinical teams [2], facilitate relay of clinical data to providers [4], and involve patients and family members [8]. There were only 8 of 37 studies that utilized an implementation science theory, model, or framework and two that explicitly addressed health disparities or equity.

SUMMARY

The mapping of the studies to implementation strategies from the ERIC compilation provides a framework for organizing current strategies to improve FH care. This study identifies potential areas for the development of implementation strategies to target unaddressed aspects of FH care.

The good, the bad, and the utilitarian: attitudes towards genetic testing and implications for disability

The present study focused on the link between the attitudes towards genetic testing and views on selective reproduction choices following genetic testing. First, we explored the potential demographical (age, gender, number of children, relationship status) and personal factors (perceived morality, religiosity, parenting intentions, instrumental harm) underlying these attitudes using a specific moral psychology approach, i.e., the two-dimension model of utilitarianism (i.e., instrumental harm and impartial beneficence). Next, we investigated participants' hypothetical reproduction choices depending on the future child's potential future condition, assessed through genetic screening. Our sample consisted of 1627 Romanian adults aged 17 to 70 (M = 24.46). Results indicated that one's perceived morality was the strongest predictor of positive attitudes towards genetic testing, and instrumental harm was the strongest predictor of negative attitudes. Also, more religious individuals with more children had more moral concerns related to genetic testing. Participants considered Down syndrome as the condition that parents (others than themselves) should most take into account when deciding to have children (35%), followed by progressive muscular dystrophy (29.1%) and major depressive disorder (29%). When expressing their choices for their future children (i.e., pregnancy termination decisions), participants' knowledge about potential deafness in their children generated the most frequent (37.7%) definitive termination decisions (i.e., "definitely yes" answers), followed by schizophrenia (35.8%), and major depressive disorder (35.2%). Finally, we discuss our results concerning their practical implications for disability and prenatal screening ethical controversies.

Educational Interventions to Improve Nurses' Competency in Genetics and Genomics: A Scoping Review

BACKGROUND

Regardless of profession and area of practice, every health care provider must possess basic knowledge and skills to integrate genetics and genomics into practice. Nurses play a pivotal role in providing health care, and they should be well equipped to apply genetics and genomics to health care settings. This scoping review explored the existing literature of educational interventions to improve nurses' competencies, including knowledge, attitudes, and skills in genetics and genomics.

METHOD

A scoping review was conducted with the Joanna Briggs Institute method for scoping reviews. We searched PubMed, Web of Science, CINAHL, and ERIC in March 2021. We included original research studies published in English in peer-reviewed journals that reported findings on the effectiveness of an educational intervention to improve nurses' competencies in genetics or genomics.

RESULTS

A total of 17 studies were included in the scoping review. Registered nurses, advanced practice nurses, and nursing faculty were targeted with different types of interventions, including face-to-face education, online/remote education, and written materials.

CONCLUSION

Limited research shows that various educational interventions improved the competencies in genetics and genomics among nurses with different degrees and areas of practice. Research is needed to evaluate the long-term effects of educational interventions by reliable assessment methods for nurses with appropriate sample sizes. [J Contin Educ Nurs. 2022;53(1):13-20.].

Experience and Perceptions of a Family Health History Risk Assessment Tool among Multi-Ethnic Asian Breast Cancer Patients

A family health history-based risk assessment is particularly valuable for guiding cancer screening and treatment strategies, yet an optimal implementation depends upon end-users' values and needs. This is not only true prior to disease development, but also for those already affected. The aim of this study is to explore perceptions of the value of knowing one's family health history (FHH)-based risk, experience using a patient-facing FHH tool and the potential of the tool for wider implementation. Twenty multi-ethnic Asian patients undergoing breast cancer treatment in Singapore completed an FHH-based risk assessment. Semi-structured one-on-one interviews were conducted and data were thematically analyzed. All participants were female and slightly more than half were Chinese. The acceptance and usage of an FHH risk assessment tool for cancers and its broader implementation was affected by a perceived importance of personal control over early detection, patient concerns of anxiety for themselves and their families due to risk results, concerns for genetic discrimination, adequacy of follow-up care plans and Asian cultural beliefs toward disease and dying. This study uniquely sheds light on the factors affecting Asian breast cancer patients' perceptions about undergoing an FHH-based risk assessment, which should inform steps for a broader implementation in Asian healthcare systems.

Remote Teaching Due to COVID-19: An Exploration of Its Effectiveness and Issues

Universities have quickly shifted to remote learning due to the COVID-19 pandemic. This study compared two versions-emergency remote teaching (ERT) and conventional face-to-face class (FFC)-of a course design based on the instructional design ARCS model for effectiveness and issues. The current study comprised 46 third-year nursing students who attended an FFC course in 2019, and 56 third-year students who took the ERT version in 2020. Students' self-rated goal attainment and knowledge of genetics scores were compared before and after taking the courses. Scores between the two class types were compared using the Wilcoxon rank sum test. The students' worksheets were evaluated using keyword frequency and content analyses. Both classes achieved their goals satisfactorily, and this study confirmed that for this course, ERT was as effective as FFC. A comparison of the increase in domain goal attainment scores per student showed that only the psychomotor domain item, "I can fully explain human diversity using genomic information", was significantly different, as it was significantly higher for ERT (p = 0.003). This higher item in the ERT group suggests that ERT can pose a lack of practice caution in acquiring nursing skills.