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Macdonald C, Mazza D, Hickey M, Hunter M, Keogh LA, Investigators KC, Jones SC, Saunders C, Nesci S, Milne RL, McLachlan SA, Hopper JL, Friedlander ML, Emery J, Phillips KA. Motivators of Inappropriate Ovarian Cancer Screening: A Survey of Women and Their Clinicians. JNCI Cancer Spectr 2021; 5:pkaa110. [PMID: 33554034 PMCID: PMC7853181 DOI: 10.1093/jncics/pkaa110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background This study examined why women and doctors screen for ovarian cancer (OC) contrary to guidelines. Methods Surveys, based on the Theoretical Domains Framework, were sent to women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer and family physicians and gynecologists who organized their screening. Results Of 1264 Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer women, 832 (65.8%) responded. In the past 2 years, 126 (15.1%) had screened. Most of these (n = 101, 80.2%) would continue even if their doctor told them it is ineffective. For women, key OC screening motivators operated in the domains of social role and goals (staying healthy for family, 93.9%), emotion and reinforcement (peace of mind, 93.1%), and beliefs about capabilities (tests are easy to have, 91.9%). Of 531 clinicians 252 (47.5%) responded; a minority (family physicians 45.8%, gynecologists 16.7%) thought OC screening was useful. For gynecologists, the main motivators of OC screening operated in the domains of environmental context (lack of other screening options, 27.6%), and emotion (patient peace of mind, 17.2%; difficulty discontinuing screening, 13.8%). For family physicians,, the strongest motivators were in the domains of social influence (women ask for these tests, 20.7%), goals (a chance these tests will detect cancer early, 16.4%), emotion (patient peace of mind, 13.8%), and environmental context (no other OC screening options, 11.2%). Conclusion Reasons for OC screening are mostly patient driven. Clinician knowledge and practice are discordant. Motivators of OC screening encompass several domains, which could be targeted in interventions to reduce inappropriate OC screening.
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Affiliation(s)
- Courtney Macdonald
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Morgan Hunter
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - kConFab Investigators
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sandra C Jones
- ACU Engagement, Australian Catholic University, Melbourne, Australia
| | | | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Montgomery SV, Barsevick AM, Egleston BL, Bingler R, Ruth K, Miller SM, Malick J, Cescon TP, Daly MB. Preparing individuals to communicate genetic test results to their relatives: report of a randomized control trial. Fam Cancer 2014; 12:537-46. [PMID: 23420550 DOI: 10.1007/s10689-013-9609-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study reports a randomized clinical trial evaluating the efficacy of an intervention to prepare individuals to communicate BRCA1/BRCA2 results to family members. Women aged 18 years and older, who had genetic testing, and who had adult first-degree relatives, were randomly assigned to a communication skills-building intervention or a wellness control session. Primary outcomes were the percentage of probands sharing test results, and the level of distress associated with sharing. The ability of the theory of planned behavior variables to predict the outcomes was explored. Four hundred twenty-two women were enrolled in the study, 219 (intervention) and 203 (control). Data from 137 in the intervention group and 112 in the control group were analyzed. Two hundred forty-nine probands shared test results with 838 relatives (80.1 %). There were no significant differences between study groups in the primary outcomes. Combining data from both arms revealed that perceived control and specific social influence were associated with sharing. Probands were more likely to share genetic test results with their children, female relatives and relatives who they perceived had a favorable opinion about learning the results. The communication skills intervention did not impact sharing of test results. The proband's perception of her relative's opinion of genetic testing and her sense of control in relaying this information influenced sharing. Communication of test results is selective, with male relatives and parents less likely to be informed. Prevalent psychosocial factors play a role in the communication of genetic test results within families.
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Affiliation(s)
- Susan V Montgomery
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Kadivar H, Goff BA, Phillips WR, Andrilla CHA, Berg AO, Baldwin LM. Nonrecommended breast and colorectal cancer screening for young women: a vignette-based survey. Am J Prev Med 2012; 43:231-9. [PMID: 22898115 DOI: 10.1016/j.amepre.2012.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/19/2012] [Accepted: 05/11/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about the prevalence of physicians offering nonrecommended breast or colorectal cancer screening for young women. PURPOSE The goal of the current paper was to examine the percentage of primary care physicians nationally who self-report offering breast or colorectal cancer screening tests for young women, and physician/practice characteristics associated with such recommendations. METHODS Analysis was performed in 2011 on data from a 2008 cross-sectional survey presenting a vignette of a health maintenance visit by an asymptomatic woman aged 35 years. This study included surveys sent to 1546 U.S. family physicians, general internists, and obstetrician-gynecologists aged <65 years, randomly selected from the AMA Physician Masterfile (60.6% response rate). Relevant respondent subsamples were used for the breast (n=505) and colorectal (n=721) cancer screening analyses. Responses were weighted to represent physicians nationally. The main outcome was physician self-report of offering breast or colorectal cancer screening tests. RESULTS 75.3% (95% CI =71.0%, 79.2%) of physicians offered breast cancer screening tests; most commonly these physicians reported offering mammography alone (76.5%, 95% CI= 71.6%, 80.8%). A total of 39.3% (95% CI=35.5%, 43.2%) of physicians offered colorectal cancer screening tests; most commonly these physicians reported offering FOBT alone (43.3%, 95% CI=37.2%, 49.6%). In adjusted analysis, physician factors associated with offering breast and colorectal cancer screening tests were: estimating higher patient breast/colorectal cancer risk, and not listing the U.S. Preventive Services Task Force as a top influential organization. CONCLUSIONS A high percentage of physicians report offering nonrecommended breast or colorectal cancer screening tests for young women. Physicians' higher cancer-risk estimation accounted for some overscreening, but even physicians who estimated the patient to be at the same risk as the general population reported offering nonrecommended screening tests.
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Affiliation(s)
- Hajar Kadivar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA.
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Abstract
This article focuses on a synthesis of knowledge about healthy aging research in human beings and then synthesized nurse-led research in gerontology and geriatrics that use biomarkers. Healthy aging research has attracted considerable attention in the biomedical and basic sciences within the context of four major areas: (a) genetic variations as an expression of successful or unsuccessful aging; (b) caloric restriction as an intervention to slow the progression of aging; (c) immunological aging; (d) neurobiology of the aging brain. A systematic review of the literature was performed to identify nurse-led geriatric-related biomarker research. Nurse researchers who have chosen to integrate biomarkers as part of their research studies have been working in six focal areas, which are reviewed: health promotion within risk populations, cancer, vascular disease, Alzheimer's disease, caregiving, and complementary therapies. The article provides a discussion of contributions to date, identifying existing gaps and future research opportunities.
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Affiliation(s)
- Hilaire J Thompson
- The University of Washington, Biobehavioral Nursing and Health Systems, Box 357266, Seattle, WA 98195-7266, USA.
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Field K, Jenkins M, Friedlander M, McKinley J, Price M, Weideman P, Keogh L, McLachlan S, Lindeman G, Hopper J, Butow P, Phillips K. Predictors of the use of complementary and alternative medicine (CAM) by women at high risk for breast cancer. Eur J Cancer 2009; 45:551-60. [DOI: 10.1016/j.ejca.2008.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/28/2008] [Accepted: 09/25/2008] [Indexed: 12/31/2022]
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MacDonald DJ, Sarna L, Giger JN, Van Servellen G, Bastani R, Weitzel JN. Comparison of Latina and non-Latina white women's beliefs about communicating genetic cancer risk to relatives. JOURNAL OF HEALTH COMMUNICATION 2008; 13:465-479. [PMID: 18661388 DOI: 10.1080/10810730802198920] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Breast cancer accounts for 30% of cancer among Latinas, and ovarian cancer is more common in Latinas than in non-Latina Whites. Latinas with a personal or family history of these cancers are increasingly referred for genetic cancer risk assessment (GCRA), but little is known about their perspectives regarding informing relatives of genetic cancer risk. We described and compared the pre-GCRA beliefs about informing relatives of genetic cancer risk, using survey data previously collected within a larger study. The sample included 475 Latina (N=183; 39%) and non-Latina (N=292; 61%) White women with a personal or family history of breast or ovarian cancers. Data analysis used descriptive statistics, chi-square and Wilcoxon rank-sum tests, and logistic regression. Findings revealed that most women believed their relatives should be informed of genetic cancer risk (92%), that informing was strictly a personal duty (88%), and that informing should be done only in person (60%). Multiple logistic regression demonstrated that education (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.15-5.66), Latina ethnicity (odds ratio [OR] 0.22, 95% CI, 0.09-0.53), and Spanish as primary language (OR, 0.17, 95% CI, 0.06-0.47) were independently associated with the belief that a clinician should be the informant.
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Affiliation(s)
- Deborah J MacDonald
- Cancer Screening & Prevention Program, Clinical Cancer Genetics Department, City of Hope Cancer Center, Duarte, California 91010-3000, USA.
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MacDonald DJ, Sarna L, van Servellen G, Bastani R, Giger JN, Weitzel JN. Selection of family members for communication of cancer risk and barriers to this communication before and after genetic cancer risk assessment. Genet Med 2008; 9:275-82. [PMID: 17505204 DOI: 10.1097/gim.0b013e31804ec075] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The impact of genetic cancer risk assessment on communication of cancer risk information within families is not fully known. We compared women's selection of family members for cancer risk communication and perceived barriers to this communication before genetic cancer risk assessment and 6 months afterward. METHODS Mailed surveys were used to collect prospective data from consenting women undergoing genetic cancer risk assessment because of a personal and/or family history of breast or ovarian cancers. Analysis included descriptive statistics, chi-square and McNemar tests, and paired t tests. RESULTS A total of 122 women met the study criteria. Although risk communications increased with first-degree relatives (84%-90% for females; 53%-62% for males) and decreased with non-first-degree relatives (21%-9%) before and after genetic cancer risk assessment, the degree of change was nonsignificant. The most commonly cited communication barrier was loss of contact (30%). Demographics, personal or family cancer history, and BRCA status did not significantly influence findings. CONCLUSIONS There was a high degree of cancer risk communications with female first-degree relatives, but less so with male first-degree relatives, both before and after genetic cancer risk assessment. For the majority of women, interpersonal barriers did not preclude risk discussions. Further research is needed to identify how best to facilitate risk communication.
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Affiliation(s)
- Deborah J MacDonald
- Clinical Cancer Genetics Department, City of Hope Cancer Center, Duarte, California 91010-3000, USA.
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MacDonald DJ, Sand S, Kass F, Blazer KR, Congleton J, Craig J, Weitzel JN. The Power of Partnership: Extending Comprehensive Cancer Center Expertise in Clinical Cancer Genetics to Community Breast Care Centers. ACTA ACUST UNITED AC 2006. [DOI: 10.1053/j.sembd.2006.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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