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Hawranek C, Rosén A, Hajdarevic S. How hereditary cancer risk disclosure to relatives is handled in practice - Patient perspectives from a Swedish cancer genetics clinic. PATIENT EDUCATION AND COUNSELING 2024; 126:108319. [PMID: 38788311 DOI: 10.1016/j.pec.2024.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/14/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Hereditary cancer risks can be effectively managed if at-risk relatives enroll in surveillance and preventive care. Family-mediated risk disclosure has internationally been shown to be incomplete, selective and leave over a third of eligible at-risk individuals without access to genetic counseling. We explored patients handling of cancer risk information in practice. METHODS We conducted twelve semi-structured interviews with patients who had completed their genetic counseling and been asked to disclose risk information to relatives. Questions were designed to investigate lived experiences of communicating hereditary risk and focused on disclosure strategies, intrafamilial interactions and emotional responses. RESULTS Qualitative content analysis yielded five categories. These span personal fears, shared responsibilities, feeling of empowerment, innovative solutions and unmet needs. Patients put high value on collaboration with their genetic healthcare professionals but also solicited better overview of the counseling process and more personalized, case-tailored information. CONCLUSIONS Our results add novel insights about the practical strategies employed by genetic counselees and their motivations behind disclosing hereditary risk information to relatives. PRACTICE IMPLICATIONS A patient-centered cancer genetics care would clarify roles and responsibilities around risk disclosure, inform counselees about the process upfront and tailor information to offer case-specific data with the family's inheritance pattern explained.
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Affiliation(s)
- Carolina Hawranek
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden.
| | - Anna Rosén
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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2
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Phillips A, Vears DF, Van Hoyweghen I, Borry P. Clinician perspectives on policy approaches to genetic risk disclosure in families. Fam Cancer 2024; 23:177-186. [PMID: 38548926 DOI: 10.1007/s10689-024-00375-2] [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: 10/24/2023] [Accepted: 03/12/2024] [Indexed: 06/06/2024]
Abstract
Genomic sequencing has emerged as a powerful tool with significant implications for patients and their relatives, however, empirical evidence suggests that effective dissemination of risk information within families remains a challenge. Policy responses to address this issue vary across countries, with Belgium notably lacking specific regulations governing nondisclosure of genetic risk. In this study, we conducted semi-structured interviews with clinicians from Belgian clinical genetics centers to gain insight into their perspectives on policy approaches to the disclosure of genetic risk within families. Using real-world examples of legislation and court rulings from France, Australia, and the UK, we explored clinician viewpoints on the roles and responsibilities of both patients and clinicians in the family communication process. Clinicians expressed confusion regarding what was legally permissible regarding contacting at-risk relatives. While there was a consensus among participants that patients have a responsibility to inform their at-risk relatives, participants were hesitant to support the legal enforcement of this duty. Clinicians mostly recognized some responsibility to at-risk relatives, but the extent of this responsibility was a subject of division. Our findings highlight the need for a comprehensive policy that clarifies the roles and responsibilities of clinicians and patients to inform at-risk relatives. Furthermore, the study underscores the practical challenges clinicians face in supporting patients through the complex process of family communication, suggesting a need for additional resources and the exploration of alternative approaches to communication.
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Affiliation(s)
- Amicia Phillips
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium.
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Melbourne Law School, University of Melbourne, Parkville, Australia
| | - Ine Van Hoyweghen
- Life Sciences and Society Lab, Center for Sociological Research, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
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Lindberg LJ, Wadt KAW, Therkildsen C, Petersen HV. National Experiences from 30 Years of Provider-Mediated Cascade Testing in Lynch Syndrome Families-The Danish Model. Cancers (Basel) 2024; 16:1577. [PMID: 38672659 PMCID: PMC11048852 DOI: 10.3390/cancers16081577] [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: 01/19/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Cascade genetic testing and surveillance reduce morbidity and mortality in Lynch syndrome. However, barriers to conveying information about genetic disorders within families result in low uptake of genetic testing. Provider-mediated interventions may increase uptake but raise legal and ethical concerns. We describe 30 years of national experience with cascade genetic testing combining family- and provider-mediated contact in Lynch syndrome families in the Danish Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Register. We aimed to estimate the added value of information letters to family members in Lynch syndrome families (provider-mediated contact) compared to family members not receiving such letters and thus relying on family-mediated contact. National clinical practice for cascade genetic testing, encompassing infrastructure, legislation, acceptance, and management of the information letters, is also discussed. Cascade genetic testing resulted in 7.3 additional tests per family. Uptake of genetic testing was 54.4% after family-mediated and 64.9% after provider-mediated contact, corresponding to an odds ratio of 1.8 (p < 0.001). The uptake of genetic testing was highest in the first year after diagnosis of Lynch syndrome in the family, with 72.5% tested after provider-mediated contact. In conclusion, the Danish model combining family- and provider-mediated contact can increase the effect of cascade genetic testing.
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Affiliation(s)
- Lars Joachim Lindberg
- The Danish HNPCC Register, Gastrounit, Copenhagen University Hospital—Amager and Hvidovre, DK2650 Hvidovre, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK2200 Copenhagen N, Denmark;
| | - Karin A. W. Wadt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK2200 Copenhagen N, Denmark;
- Department of Clinical Genetics, Rigshospitalet, DK2100 Copenhagen Ø, Denmark
| | - Christina Therkildsen
- The Danish HNPCC Register, Gastrounit, Copenhagen University Hospital—Amager and Hvidovre, DK2650 Hvidovre, Denmark;
| | - Helle Vendel Petersen
- Medical Department, Zealand University Hospital, DK4800 Nykøbing Falster, Denmark;
- Clinical Research Centre, Copenhagen University Hospital, DK2650 Hvidovre, Denmark
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Rosén A, Krajc M, Ehrencrona H, Bajalica-Lagercrantz S. Public attitudes challenge clinical practice on genetic risk disclosure in favour of healthcare-provided direct dissemination to relatives. Eur J Hum Genet 2024; 32:6-7. [PMID: 37474788 PMCID: PMC10772116 DOI: 10.1038/s41431-023-01428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
| | - Mateja Krajc
- Department of Clinical Cancer Genetics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Hans Ehrencrona
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Svetlana Bajalica-Lagercrantz
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Hereditary Cancer Unit, Karolinska University Hospital, Stockholm, Sweden
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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.
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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
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Hawranek C, Ehrencrona H, Öfverholm A, Hellquist BN, Rosén A. Direct letters to relatives at risk of hereditary cancer-study protocol for a multi-center randomized controlled trial of healthcare-assisted versus family-mediated risk disclosure at Swedish cancer genetics clinics (DIRECT-study). Trials 2023; 24:810. [PMID: 38105176 PMCID: PMC10726564 DOI: 10.1186/s13063-023-07829-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The results of germline genetic testing for hereditary cancer are of importance not only to the patients under investigation but also to their genetic at-risk relatives. Standard care is to encourage the proband (first family member under investigation) to pass on this risk information to the relatives. Previous research suggests that with family-mediated disclosure, only about a third of at-risk relatives contact health care to receive genetic counselling. In some studies, complementing family-mediated risk disclosure with healthcare-assisted risk disclosure almost doubles the uptake of genetic counselling in at-risk relatives. In this study, we evaluate healthcare-assisted direct letters to relatives at risk of hereditary cancer syndromes in a randomized controlled trial. METHODS Probands are recruited from Swedish outpatient cancer genetics clinics to this two-arm randomized controlled trial. The study recruits probands with either a pathogenic variant in a cancer susceptibility gene (BRCA1, BRCA2, PALB2, MLH1, MSH2, MSH6, PMS2) or probands with familial breast and colorectal cancer based on clinical and pedigree criteria. In both arms, probands receive standard care, i.e., are encouraged and supported to pass on information to relatives. In the intervention arm, the proband is also offered to have direct letters sent to the at-risk relatives. The primary outcome measure is the proportion of at-risk relatives contacting a Swedish cancer genetics clinic within 12 months of the proband receiving the test results. DISCUSSION This paper describes the protocol of a randomized controlled clinical trial evaluating a healthcare-assisted approach to risk disclosure by offering the probands to send direct letters to their at-risk relatives. The results of this study should be informative in the future development of risk disclosure practices in cancer genetics clinics. TRIAL REGISTRATION ClinicalTrials.gov. Identifier NCT04197856 (pre-trial registration on December 13, 2019). Also registered at the website "RCC Cancerstudier i Sverige" as study #86719.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Hans Ehrencrona
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Öfverholm
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | | | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
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Phillips A, Dewitte I, Debruyne B, Vears DF, Borry P. Disclosure of genetic risk in the family: A survey of the Flemish general population. Eur J Med Genet 2023:104800. [PMID: 37336289 DOI: 10.1016/j.ejmg.2023.104800] [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: 02/03/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Results from genomic sequencing often have implications not just for patients but also for their relatives. To date, there are no studies in Belgium exploring whether potential relatives would want to be informed of a genetic risk in the family and their preferences on different approaches to disclosure. METHODS We surveyed the attitudes of the Flemish general population (n = 407) towards receiving genetic information from their family members, including attitudes towards breaches in confidentiality, preferences for who communicates genetic risk and how the information is communicated, and policy approaches to nondisclosure. RESULTS Most participants wanted to be informed of their genetic risk and receive genetic testing to confirm their diagnosis. Most preferred to be informed of genetic risk by a close family member, but that when given the choice between a distant family member and a clinician, most participants preferred to be contacted by a clinician. CONCLUSION In Belgium there is currently no clear legal pathway for clinicians to directly initiate contact with at-risk relatives, but the responses from members of the Flemish population analyzed in this study indicate that this approach to disclosure of genetic risk deserves further consideration. Our findings indicate that the general population would support legislation allowing clinicians to inform relatives even in cases where the patient did not want to inform them. As this is not currently allowed in Belgium, policy alternatives should be considered.
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Affiliation(s)
- Amicia Phillips
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Iris Dewitte
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bo Debruyne
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Danya F Vears
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Melbourne Law School, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Blasi PR, Scrol A, Anderson ML, Gray MF, Tiffany B, Fullerton SM, Ralston JD, Leppig KA, Henrikson NB. Feasibility, acceptability, and limited efficacy of health system-led familial risk notification: protocol for a mixed-methods evaluation. Pilot Feasibility Stud 2022; 8:174. [PMID: 35945632 PMCID: PMC9361690 DOI: 10.1186/s40814-022-01142-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Genetic testing for pathogenic variants associated with hereditary breast and ovarian cancer risk can improve cancer outcomes through enhanced preventive care in both people with known variants and their biologic relatives. Cascade screening—the process of case-finding in relatives by notifying and inviting them to consider testing—currently relies on the patient to notify their own at-risk relatives. However, many of these relatives never learn they might be at risk. We developed and implemented a new health system-led familial genetic risk notification process where the care team offers to contact at-risk relatives directly. This protocol describes a study to assess the feasibility, acceptability, and limited efficacy of this intervention. Methods This feasibility study will use a single-arm, nonrandomized, mixed-methods prospective design. We will enroll two groups of participants: probands and relatives of probands. Eligible probands are currently enrolled Kaiser Permanente Washington (KPWA) members with an upcoming appointment for pre-test genetic counseling for hereditary Lynch syndrome, breast, or ovarian cancer. Eligible relatives, who do not have to be KPWA members, are first-and second-degree relatives of probands. During the appointment with the proband, the genetic counselor will determine whether the proband is appropriate for genetic testing and if so, which relatives might benefit from cascade testing. The genetic counselor then will offer to contact any or all identified relatives directly to discuss genetic risk and testing. The primary outcome of this study is the feasibility of the implemented familial notification process, which we will measure using quantitative and qualitative data on intervention reach, intervention acceptability, and limited efficacy. Analyses will be primarily descriptive and exploratory, with the intent of preparing for a future, larger trial of direct contact interventions. Discussion Our findings will provide new, foundational evidence for the creation of US-based familial notification systems that directly address logistical and ethical challenges while prioritizing the preferences of patients and families. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01142-9.
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Affiliation(s)
- Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Aaron Scrol
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Marlaine Figueroa Gray
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | | | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
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Hawranek C, Maxon J, Andersson A, Van Guelpen B, Hajdarevic S, Numan Hellquist B, Rosén A. Cancer Worry Distribution and Willingness to Undergo Colonoscopy at Three Levels of Hypothetical Cancer Risk—A Population-Based Survey in Sweden. Cancers (Basel) 2022; 14:cancers14040918. [PMID: 35205668 PMCID: PMC8870195 DOI: 10.3390/cancers14040918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Cancer worry is a known health concern in cancer patients and people with a genetic predisposition to cancer. We measured how worried people, in general, are about developing cancer to describe levels in non-affected individuals. In total, 943 respondents completed a survey containing the Cancer Worry Scale (CWS) and hypothetical questions asking if they would attend a colonoscopy screening at a 5, 10, or 70 percent lifetime risk of developing bowel cancer. Unaffected individuals scored a mean of 9.46 on the six-item CWS. Women scored significantly higher than men (9.91 vs. 9.06). Women and parents had higher cancer worry than men and people without children when ruling out differences in education, age, and country of birth. People who worried more were also more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk. These data may be helpful in future work on cancer worry and cancer prevention. Abstract Purpose: We describe levels of cancer worry in the general population as measured with the Cancer Worry Scale (CWS) and investigate the association with colonoscopy screening intentions in three colorectal cancer risk scenarios. Methods: The data were sourced through a population-based survey. Respondents (n = 943) completed an eight-item CWS and questions on colonoscopy screening interest at three hypothetical risk levels. Results: Respondents without a personal cancer history (n = 853) scored 9.46 on the six-item CWS (mean, SD 2.72). Mean scores were significantly higher in women (9.91, SD 2.89) as compared to men (9.06, SD 2.49, p < 0.001). Linear regression showed higher cancer worry in women and those with children when controlling for education, age group, and country of birth. High cancer worry (six-item CWS mean >12) was identified in 25% of women and in 17% of men. Among those, 71% would attend a colonoscopy screening compared to 52% of those with low cancer worry (p < 0.001, 5% CRC-risk). Conclusions: The distribution of cancer worry in a general population sample showed higher mean scores in women, and levels overlapped with earlier findings in cancer-affected samples. Respondents with high cancer worry were more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Correspondence: ; Tel.: +46-76-69-60-648
| | - Johan Maxon
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Andreas Andersson
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
- Wallenberg Centre for Molecular Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Barbro Numan Hellquist
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
| | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden; (J.M.); (A.A.); (B.V.G.); (B.N.H.); (A.R.)
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Siira E, Wolf A. Are digital citizen panels an innovative, deliberative approach to cardiovascular research? Eur J Cardiovasc Nurs 2022; 21:287-291. [PMID: 35030241 DOI: 10.1093/eurjcn/zvab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/14/2022]
Abstract
Online citizen panels are an innovative way to collect information about populations. They can help explain social determinants of health while involving citizens in research, allowing researchers to help the community, and advance cardiovascular research. This paper discusses the advantages and disadvantages of collecting information via online citizen panels and assesses these panels' potential in cardiovascular research. To exemplify such panels' use, we discuss a case study that utilized the Swedish Citizen Panel.
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Affiliation(s)
- Elin Siira
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe Building 4, 413 46 Göteborg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe Building 4, 413 46 Göteborg, Sweden.,University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Arvid Wallgrens Backe Building 4, 413 46 Göteborg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85 Göteborg, Sweden.,Institute of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs plass 0130 Oslo, Norway
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Hawranek C, Hajdarevic S, Rosén A. A Focus Group Study of Perceptions of Genetic Risk Disclosure in Members of the Public in Sweden: "I'll Phone the Five Closest Ones, but What Happens to the Other Ten?". J Pers Med 2021; 11:jpm11111191. [PMID: 34834542 PMCID: PMC8622605 DOI: 10.3390/jpm11111191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
This study explores perceptions and preferences on receiving genetic risk information about hereditary cancer risk in members of the Swedish public. We conducted qualitative content analysis of five focus group discussions with participants (n = 18) aged between 24 and 71 years, recruited from various social contexts. Two prominent phenomena surfaced around the interplay between the three stakeholders involved in risk disclosure: the individual, healthcare, and the relative at risk. First, there is a genuine will to share risk information that can benefit others, even if this is difficult and causes discomfort. Second, when the duty to inform becomes overwhelming, compromises are made, such as limiting one’s own responsibility of disclosure or projecting the main responsibility onto another party. In conclusion, our results reveal a discrepancy between public expectations and the actual services offered by clinical genetics. These expectations paired with desire for a more personalized process and shared decision-making highlight a missing link in today’s risk communication and suggest a need for developed clinical routines with stronger healthcare–patient collaboration. Future research needs to investigate the views of genetic professionals on how to address these expectations to co-create a transparent risk disclosure process which can realize the full potential of personalized prevention.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden;
- Correspondence: ; Tel.: +46-76-89-34-504
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden;
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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: 15] [Impact Index Per Article: 5.0] [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.
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Grill K, Rosén A. Healthcare professionals' responsibility for informing relatives at risk of hereditary disease. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106236. [PMID: 33246998 PMCID: PMC8639958 DOI: 10.1136/medethics-2020-106236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 05/10/2023]
Abstract
Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients' relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients' at-risk relatives. We do not try to settle the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one's genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient's duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility.
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Affiliation(s)
- Kalle Grill
- Radiation Sciences, Umeå university, Umeå, Sweden
| | - Anna Rosén
- Radiation Sciences, Umeå university, Umeå, Sweden
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