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Le TD, Lin SC, Huang MC, Fan SY, Kao CY. Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis. Nurs Ethics 2024; 31:714-738. [PMID: 37818823 DOI: 10.1177/09697330231200570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. OBJECTIVE The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. METHODS A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. RESULTS 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. CONCLUSIONS Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.
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Affiliation(s)
| | | | - Mei-Chih Huang
- National Cheng Kung University, Taiwan
- National Tainan Junior College of Nursing, Taiwan
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Austin S, Hanson EN, Delacroix E, Bacon E, Rice J, Gerido LH, Rizzo E, Pleasant V, Stoffel EM, Griggs JJ, Resnicow K. Impact of barriers and motivators on intention and confidence to undergo hereditary cancer genetic testing. J Genet Couns 2024. [PMID: 38803214 DOI: 10.1002/jgc4.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
Genetic testing for hereditary cancer syndromes can provide lifesaving information allowing for individualized cancer screening, prevention, and treatment. However, the determinants, both barriers and motivators, of genetic testing intention are not well described. A survey of barriers and motivators to genetic testing was emailed to adult patients eligible for genetic testing based on cancer diagnosis who previously have not had genetic testing (n = 201). Associations between barriers/motivators with testing intention and confidence were examined first by correlation followed by multivariable linear regression model holding constant potential covariates. Seven barrier items from two domains (logistics and genetic testing knowledge) were found to significantly negatively correlate with genetic testing intention. Unexpectedly, three barrier items had significant positive correlation with genetic testing intention; these were related to family worry (passing a condition on to future generations) and testing knowledge (needing more information on the genetic testing process and what it has to offer). Ten barrier items had significant negative correlation with confidence to get a genetic test and encompassed four domains: stigma, insurance/genetic discrimination, knowledge, and cost. All motivator items were associated with intention to get a genetic test, while none were associated with confidence. Multivariable analysis yielded six total barriers (five from the knowledge domain, one from cost domain) and two motivators (relieved to know and treatment impact) that were significantly associated with genetic testing intention or confidence when controlling for demographic characteristics. These findings indicate the need for tailored interventions to amplify motivating factors and counter-message barriers to enhance patient motivation and confidence to undergo testing.
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Affiliation(s)
- Sarah Austin
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Erika N Hanson
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Emerson Delacroix
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth Bacon
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - John Rice
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Elizabeth Rizzo
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Versha Pleasant
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Elena M Stoffel
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Jennifer J Griggs
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ken Resnicow
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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He M, Guan J, Li H, Dong Y, Zhu X, Sun J, Gao S, Zhi S, Ai Ni BHLQM, Sun J. Genetic testing decision-making experiences within families of colorectal cancer patients: A qualitative study. Eur J Oncol Nurs 2023; 66:102417. [PMID: 37741145 DOI: 10.1016/j.ejon.2023.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/05/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Genetic testing is the gold standard for the diagnosis of hereditary colorectal cancer syndromes but is currently inadequate and nonideal. The decision-making processes regarding genetic testing are even less well known. The present study aims to explore the decision-making experience of genetic testing for colorectal cancer patients and their family members. METHOD A descriptive qualitative study was employed. Data were collected using individual semi-structured interviews with 5 colorectal cancer patients and 20 family members from November 2020 to April 2021. Interviews were transcribed and analysed using inductive content analysis. RESULTS Four categories were identified: 1) the source of information for genetic testing, 2) the differentiated attitudes towards genetic testing, 3) genetic testing decisional needs, and 4) the factors influencing genetic testing decision-making. Colorectal cancer patients and their families engaged in two distinct pathways to genetic testing decisions: direct decision-making and indirect decision-making. Throughout these processes, due to the limited source of information, they had information needs that were met and facilitated genetic testing decision-making. CONCLUSIONS Colorectal cancer patients and family members need knowledge related to genetic testing, but they have limited access to information, which prevents them from making informed decisions. Providing decision aid interventions and informational support are significant steps towards addressing the support needs of this population.
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Affiliation(s)
- Meng He
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Jingjing Guan
- The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Huanhuan Li
- Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China.
| | - Yueyang Dong
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Xiangning Zhu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Juanjuan Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Shizheng Gao
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Shengze Zhi
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Bu He Li Qian Mu Ai Ni
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
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4
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Crown A, Fazeli S, Kurian AW, Ochoa DA, Joseph KA. Disparity in Breast Cancer Care: Current State of Access to Screening, Genetic Testing, Oncofertility, and Reconstruction. J Am Coll Surg 2023; 236:1233-1239. [PMID: 36971366 DOI: 10.1097/xcs.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women, accounting for an estimated 30% of all new cancer diagnoses in women in 2022. Advances in breast cancer treatment have reduced the mortality rate over the past 25 years by up to 34% but not all groups have benefitted equally from these improvements. These disparities span the continuum of care from screening to the receipt of guideline-concordant therapy and survivorship. At the 2022 American College of Surgeons Clinical Congress, a panel session was dedicated to educating and discussing methods of addressing these disparities in a coordinated manner. While there are multilevel solutions to address these disparities, this article focuses on screening, genetic testing, reconstruction, and oncofertility.
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Affiliation(s)
- Angelena Crown
- From the True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA (Crown)
| | | | - Allison W Kurian
- Division of Oncology, Population Sciences Program, Stanford Cancer Institute, Stanford, CA (Kurian)
- Women's Clinical Cancer Genetics Program, Stanford University School of Medicine, Stanford, CA (Kurian)
| | - Daniela A Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Science, Little Rock, AR (Ochoa)
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, New York, NY (Joseph)
- NYU Langone Health Institute for Excellence in Health Equity, New York, NY (Joseph)
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Hanson EN, Delacroix E, Austin S, Carr G, Kidwell KM, Bacon E, Gerido LH, Griggs JJ, Stoffel EM, Resnicow K. Psychosocial factors impacting barriers and motivators to cancer genetic testing. Cancer Med 2023; 12:9945-9955. [PMID: 36808717 PMCID: PMC10166953 DOI: 10.1002/cam4.5709] [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: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Only a small proportion of patients who qualify for clinical genetic testing for cancer susceptibility get testing. Many patient-level barriers contribute to low uptake. In this study, we examined self-reported patient barriers and motivators for cancer genetic testing. METHODS A survey comprised of both new and existing measures related to barriers and motivators to genetic testing was emailed to patients with a diagnosis of cancer at a large academic medical center. Patients who self-reported receiving a genetic test were included in these analyses (n = 376). Responses about emotions following testing as well as barriers and motivators prior to getting testing were examined. Group differences in barriers and motivators by patient demographic characteristics were examined. RESULTS Being assigned female at birth was associated with increased emotional, insurance, and family concerns as well as increased health benefits compared to patients assigned male at birth. Younger respondents had significantly higher emotional and family concerns compared to older respondents. Recently diagnosed respondents expressed fewer concerns about insurance implications and emotional concerns. Those with a BRCA-related cancer had higher scores on social and interpersonal concerns scale than those with other cancers. Participants with higher depression scores indicated increased emotional, social and interpersonal, and family concerns. CONCLUSIONS Self-reported depression emerged as the most consistent factor influencing report of barriers to genetic testing. By incorporating mental health resources into clinical practice, oncologists may better identify those patients who might need more assistance following through with a referral for genetic testing and the response afterwards.
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Affiliation(s)
- Erika N. Hanson
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Emerson Delacroix
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah Austin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Grant Carr
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Kelley M. Kidwell
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Elizabeth Bacon
- Center for Health Communications Research, Rogel Cancer Center, Michigan MedicineAnn ArborMichiganUSA
| | - Lynette Hammond Gerido
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/OncologyUniversity of MichiganAnn ArborMichiganUSA
- School of Public Health, Department of Health Management and PolicyUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Elena M. Stoffel
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Ken Resnicow
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
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6
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Finn CM, McCormick S, Peterson D, Niendorf KB, Rodgers LH. Motivation and family communication in hereditary prostate cancer genetic testing: Survey of patients from a US tertiary medical center. J Genet Couns 2023; 32:79-89. [PMID: 35941805 DOI: 10.1002/jgc4.1624] [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: 11/03/2021] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
Identification of a hereditary prostate cancer in an affected individual can guide treatment and may also impact cancer screening and surveillance for patients and their relatives. This study aimed to determine the factors that are associated with the decision-making process of individuals with prostate cancer regarding whether to pursue genetic testing as well as how, why, and with whom genetic test results are shared. We surveyed 113 patients diagnosed with prostate cancer who received cancer genetic counseling through a United States tertiary medical center, inquiring about genetic testing motivations and family communication about results. Among those who pursued genetic testing, (1) learning about my family's possible cancer risk (98%), (2) learning information that may guide cancer treatment (93%), and (3) learning if I am at risk for future cancers (92%) were most frequently identified as slightly or very important factors in their decision. Participants shared their genetic test results in a higher proportion to male first-degree relatives than female first-degree relatives; however, no significant difference was found (p = 0.103). Our study may suggest sex differences related to family communication about genetic testing results. Such findings indicate a critical need for genetic counselors to clearly communicate the impact of genetic test results on both male and female relatives. Further research on motivation and family communication about genetic test results in diverse cohorts is needed.
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Affiliation(s)
- Caitlin M Finn
- MGH Institute of Health Professions Genetic Counseling Program, Boston, Massachusetts, USA.,Massachusetts General Hospital, Cancer Center, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shelley McCormick
- Massachusetts General Hospital, Cancer Center, Boston, Massachusetts, USA
| | - Danielle Peterson
- MGH Institute of Health Professions Genetic Counseling Program, Boston, Massachusetts, USA
| | - Kristin B Niendorf
- MGH Institute of Health Professions Genetic Counseling Program, Boston, Massachusetts, USA
| | - Linda H Rodgers
- Massachusetts General Hospital, Cancer Center, Boston, Massachusetts, USA
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Relatives from Hereditary Breast and Ovarian Cancer and Lynch Syndrome Families Forgoing Genetic Testing: Findings from the Swiss CASCADE Cohort. J Pers Med 2022; 12:jpm12101740. [PMID: 36294879 PMCID: PMC9605198 DOI: 10.3390/jpm12101740] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cascade genetic testing of relatives from families with pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) or Lynch syndrome (LS) has important implications for cancer prevention. We compared the characteristics of relatives from HBOC or LS families who did not have genetic testing (GT (−) group) with those who had genetic testing (GT (+) group), regardless of the outcome. Self-administered surveys collected cross-sectional data between September 2017 and December 2021 from relatives participating in the CASCADE cohort. We used multivariable logistic regression with LASSO variable selection. Among n = 115 relatives who completed the baseline survey, 38% (n = 44) were in the GT (−) group. Being male (OR: 2.79, 95% CI: 1.10–7.10) and without a previous cancer diagnosis (OR: 4.47, 95% CI: 1.03–19.42) increased the odds of being untested by almost three times. Individuals from families with fewer tested relatives had 29% higher odds of being untested (OR: 0.71, 95% CI: 0.55–0.92). Reasons for forgoing cascade testing were: lack of provider recommendation, lack of time and interest in testing, being afraid of discrimination, and high out-of-pocket costs. Multilevel interventions designed to increase awareness about clinical implications of HBOC and LS in males, referrals from non-specialists, and support for testing multiple family members could improve the uptake of cascade testing.
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Awareness, Knowledge, Perceptions, and Attitudes towards Familial and Inherited Cancer. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101400. [PMID: 36295561 PMCID: PMC9611391 DOI: 10.3390/medicina58101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: In 2020, the World Health Organization (WHO) reported 9.9 million deaths from cancer, with a mortality rate of 10.65%. Early detection of cancer can decrease mortality and increase the chance of cure. In Saudi Arabia, multiple studies were performed for awareness and attitudes toward cancer, but few studies evaluated the awareness of familial and inherited cancers. Materials and Methods: This is a cross-sectional observational survey of the awareness, knowledge, and attitudes of Saudi women toward familial and inherited cancers. The estimated sample size was 385. Questionnaires were distributed through social media platforms from 1 January 2021 to 22 January 2021. Results: Of the 385 participants, the majority have a bachelor’s degree. More than half (68.9%) know that family history is related to cancer, and approximately 57.2% are aware of genetic testing. The most common indication of genetic testing is premarital testing (18.5%). An inverse relationship is noted between the awareness of familial and inherited cancers and age (p = 0.003, CI = 0.723−0.938). However, awareness of inherited and familial cancer is positively associated with awareness of the association of genetic mutation to cancer (p = 0.013, CI = 1.080−1.921) and knowledge about genetic testing (p > 0.000, CI = 2.487−8.426). Conclusions: Our results reveal that Saudi women, especially older adults, have suboptimal knowledge about inherited and familial cancers, and poor attitudes toward genetic screening. We recommend increasing public awareness regarding risk factors and screening for inherited and familial cancers.
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Hussen BM, Abdullah ST, Salihi A, Sabir DK, Sidiq KR, Rasul MF, Hidayat HJ, Ghafouri-Fard S, Taheri M, Jamali E. The emerging roles of NGS in clinical oncology and personalized medicine. Pathol Res Pract 2022; 230:153760. [PMID: 35033746 DOI: 10.1016/j.prp.2022.153760] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 02/07/2023]
Abstract
Next-generation sequencing (NGS) has been increasingly popular in genomics studies over the last decade, as new sequencing technology has been created and improved. Recently, NGS started to be used in clinical oncology to improve cancer therapy through diverse modalities ranging from finding novel and rare cancer mutations, discovering cancer mutation carriers to reaching specific therapeutic approaches known as personalized medicine (PM). PM has the potential to minimize medical expenses by shifting the current traditional medical approach of treating cancer and other diseases to an individualized preventive and predictive approach. Currently, NGS can speed up in the early diagnosis of diseases and discover pharmacogenetic markers that help in personalizing therapies. Despite the tremendous growth in our understanding of genetics, NGS holds the added advantage of providing more comprehensive picture of cancer landscape and uncovering cancer development pathways. In this review, we provided a complete overview of potential NGS applications in scientific and clinical oncology, with a particular emphasis on pharmacogenomics in the direction of precision medicine treatment options.
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Affiliation(s)
- Bashdar Mahmud Hussen
- Department Pharmacognosy, College of Pharmacy, Hawler Medical University, Kurdistan Region, Erbil, Iraq; Center of Research and Strategic Studies, Lebanese French University, Kurdistan Region, Erbil, Iraq
| | - Sara Tharwat Abdullah
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Abbas Salihi
- Center of Research and Strategic Studies, Lebanese French University, Kurdistan Region, Erbil, Iraq; Department of Biology, College of Science, Salahaddin University, Kurdistan Region, Erbil, Iraq
| | - Dana Khdr Sabir
- Department of Medical Laboratory Sciences, Charmo University, Kurdistan Region, Iraq
| | - Karzan R Sidiq
- Department of Biology, College of Education, University of Sulaimani, Sulaimani 334, Kurdistan, Iraq
| | - Mohammed Fatih Rasul
- Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Kurdistan Region, Erbil, Iraq
| | - Hazha Jamal Hidayat
- Department of Biology, College of Education, Salahaddin University, Kurdistan Region, Erbil, Iraq
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- Institute of Human Genetics, Jena University Hospital, Jena, Germany; Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elena Jamali
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Alarie S, Hagan J, Dalpé G, Faraji S, Mbuya-Bienge C, Nabi H, Pashayan N, Brooks JD, Dorval M, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Paquette JS, Walker MJ, Lapointe J, Granados Moreno P, Blackmore K, Wolfson M, Broeders M, Knoppers BM, Chiarelli AM, Simard J, Joly Y. Risk-Stratified Approach to Breast Cancer Screening in Canada: Women's Knowledge of the Legislative Context and Concerns about Discrimination from Genetic and Other Predictive Health Data. J Pers Med 2021; 11:jpm11080726. [PMID: 34442372 PMCID: PMC8398750 DOI: 10.3390/jpm11080726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of this study was twofold. First, to evaluate Canadian women’s knowledge of the legislative context governing GD. Second, to assess their concerns about the possible use of breast cancer risk levels by insurance companies or employers. We use a cross-sectional survey of 4293 (age: 30–69) women, conducted in four Canadian provinces (Alberta, British Colombia, Ontario and Québec). Canadian women’s knowledge of the regulatory framework for GD is relatively limited, with some gaps and misconceptions noted. About a third (34.7%) of the participants had a lot of concerns about the use of their health information by employers or insurers; another third had some concerns (31.9%), while 20% had no concerns. There is a need to further educate and inform the Canadian public about GD and the legal protections that exist to prevent it. Enhanced knowledge could facilitate the implementation and uptake of risk prediction informed by genetic factors, such as the risk-stratified approach to breast cancer screening that includes risk levels.
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Affiliation(s)
- Samuel Alarie
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
- Correspondence: ; Tel.: +1-(514)-398-8155
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Sina Faraji
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Cynthia Mbuya-Bienge
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London WC1E 6BT, UK;
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 4G2, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, QC G6V 3Z1, Canada
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- CHU de Québec-Université Laval, Quebec City, QC G1S 4L8, Canada
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada;
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Laurence Lambert-Côté
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Jean-Sébastien Paquette
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Meghan J. Walker
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada;
| | - Julie Lapointe
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | | | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada;
| | - Mireille Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, 525 EZ Nijmegen, The Netherlands;
- Dutch Expert Centre for Screening, 6538 SW Nijmegen, The Netherlands
| | | | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
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11
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Jones T, Howard H, Freeman-Costin K, Creighton A, Wisdom-Chambers K, Underhill-Blazey M. Knowledge and perceptions of BRCA1/2 genetic testing and needs of diverse women with a personal or family history of breast cancer in South Florida. J Community Genet 2021; 12:415-429. [PMID: 33555545 PMCID: PMC8241944 DOI: 10.1007/s12687-021-00507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022] Open
Abstract
The vast majority of (BRCA1/2) genetic testing has been conducted in White women, in particular Ashkenazi Jewish women, with limited information available for Black and Hispanic women. Understanding perspectives of those who are underserved is critical to developing interventions to support inclusive approaches to genetic testing. This qualitative study explored knowledge and perceptions of BRCA1/2 genetic testing among diverse women in South Florida. We also explored participants' information needs. Convenience sampling was used to recruit a diverse group of 15 women with a personal or family history of breast cancer. We conducted semi-structured interviews and used grounded theory method to analyze the data. Five themes were identified: (1) lacking awareness and knowledge of BRCA1/2 genetic testing and results among Black women, (2) perceiving BRCA1/2 genetic testing as beneficial to themselves and a way to be proactive about cancer risk, (3) perceiving BRCA1/2 genetic testing as beneficial to family members, (4) interactions with healthcare providers and the healthcare system that shape genetic testing experiences, and (5) information needs for reducing cancer risk and promoting health. Our findings suggest that diverse underserved women perceived genetic testing as beneficial to themselves and family members. Women needed more information about the BRCA genes and genetic testing, prevention strategies, and the latest breast cancer research. Healthcare providers, particularly nurse practitioners, need to engage diverse high-risk women in discussions about their cancer risk, address unmet information needs, and, in particular, educate Black women about the benefits of pursuing genetic testing.
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Affiliation(s)
- Tarsha Jones
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA.
| | - Heather Howard
- College for Design and Social Inquiry, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Katherine Freeman-Costin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Ana Creighton
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Karen Wisdom-Chambers
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Meghan Underhill-Blazey
- School of Nursing, University of Rochester, Rochester, NY, 14642, USA
- Dana Farber Cancer Institute, Boston, Massachusetts, 02215, USA
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12
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Kast K, Häfner J, Schröck E, Jahn A, Werner C, Meisel C, Wimberger P. Recommendation and Acceptance of Counselling for Familial Cancer Risk in Newly Diagnosed Breast Cancer Cases. Breast Care (Basel) 2021; 17:153-158. [DOI: 10.1159/000517021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In clinical routine, not every patient who is offered genetic counselling and diagnostics in order to investigate a familial cancer risk predisposition opts for it. Little is known about acceptance of counselling and testing in newly diagnosed breast cancer cases in Germany. <b><i>Methods:</i></b> All primary breast cancer cases and patients with DCIS (ductal carcinoma in situ) treated at the University Hospital of Dresden between 2016 and 2019 were included. The number of tumor board recommendations for genetic counselling on the basis of the GC-HBOC risk criteria was recorded. Acceptance was analyzed by number of cases with counselling in the GC-HBOC-Center Dresden. <b><i>Results:</i></b> Of 996 primary breast cancer and DCIS cases, 262 (26.3%) were eligible for genetic counselling. Recommendation for genetic counselling was accepted by 64.1% (168/262). Of these 90.5% (152/168) opted for molecular genetic analysis. The acceptance rate for counselling increased between 2016 and 2019 from 58.3 to 72.6%. Altogether, 20.4% (31/152) patients were found to carry a pathogenic variant in the breast cancer genes <i>BRCA1</i> or <i>BRCA2</i>. <b><i>Conclusion:</i></b> Acceptance of recommendation is increasing as clinical consequences augment. Optimization in providing information about hereditary cancer risk and in accessibility of counselling and testing is required to further improve acceptance of recommendation.
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Association of Family History with the Development of Breast Cancer: A Cohort Study of 129,374 Women in KoGES Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126409. [PMID: 34199253 PMCID: PMC8296242 DOI: 10.3390/ijerph18126409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Background: Breast cancer is the most common cancer among women. The Korean Genome and Epidemiology Study (KoGES) is a large cohort study that is available to the public. Using this large cohort study, we aimed to unravel the relationship between breast cancer development and a family history of breast cancer in Korea. Methods: This cohort study relied on data from the KoGES from 2001 through 2013. A total of 211,725 participants were screened. Of these, 129,374 women were evaluated. They were divided into two groups, including participants with and without breast cancer. A logistic regression model was used to retrospectively analyze the odds ratio of breast cancer history in families of women with and without breast cancer. Results: Of 129,374 women, 981 had breast cancer. The breast cancer group had more mothers and siblings with histories of breast cancer (p < 0.001). A history of breast cancer in the participant’s mother resulted in an odds ratio of 3.12 (1.75–5.59), and a history of breast cancer in the participant’s sibling resulted in an odds ratio of 2.63 (1.85–3.74). There was no interaction between the history of maternal breast cancer and the history of sibling breast cancer. Based on the subgroup analysis, family history was a stronger factor in premenopausal women than in menopausal and postmenopausal women. Conclusions: A family history of breast cancer is a significant risk factor for breast cancer in Korea. Premenopausal women with a maternal history of breast cancer are of particular concern. Intensive screening and risk-reducing strategies should be considered for this vulnerable subpopulation.
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Ding H, Sutton AL, Hurtado-de-Mendoza A, Sheppard VB. The role of psychosocial factors in Black women's self-efficacy in receiving genetic counseling and testing. J Genet Couns 2021; 30:1719-1726. [PMID: 34085362 DOI: 10.1002/jgc4.1439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
Higher self-efficacy in receiving genetic counseling and testing (GCT) has been associated with greater participation in GCT for women at risk of hereditary breast and ovarian cancer (HBOC), but little is known about correlates of self-efficacy in Black women eligible for GCT. The goal of this secondary analysis was to identify sociodemographic and psychosocial factors regarding GCT. Multivariable regression analysis was conducted to assess the relationship between self-efficacy and correlates of interest. Of the 100 Black women surveyed, most women had a college degree (64%), were employed (84%), and had health insurance (93%). In the multivariable model, greater self-efficacy was associated with more positive attitudes toward GCT (Β = 0.126; CI = 0.01 to 0.25; p = 0.039), greater confidence in the Genetic Information Nondiscrimination Act (GINA) (Β = 0.250; CI = 0.04 to 0.46; p = 0.019), and lower ratings of perceived difficulty obtaining GCT (Β = -0.219; CI = -0.46 to -0.10; p = 0.003). Community-level interventions to promote self-efficacy are needed that address perceived barriers to GCT, with the goals of increasing GINA Law awareness in the general public, increasing accessibility to genetic counseling (e.g., telemedicine), and promoting more positive attitudes about GCT.
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Affiliation(s)
- Huanghe Ding
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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15
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Reyes KG, Clark C, Gerhart M, Newson AJ, Ormond KE. "I wish that there was more info": characterizing the uncertainty experienced by carriers of pathogenic ATM and/or CHEK2 variants. Fam Cancer 2021; 21:143-155. [PMID: 33855648 DOI: 10.1007/s10689-021-00251-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/04/2021] [Indexed: 12/29/2022]
Abstract
Little is known about what uncertainties patients experience after being identified to carry a pathogenic variant in a moderate-risk cancer gene as a result of undergoing multigene panel testing for cancer susceptibility. Data regarding cancer risk estimates and effectiveness of risk management strategies for these variants continues to evolve, which has the potential to evoke uncertainty. Acknowledging uncertainty during pre- and post-test discussions is imperative to helping individuals to adapt to their results. A better understanding of this population's experience of uncertainty is needed to facilitate such discussions and is the aim of the current study. Semi-structured interviews (30-60 min in length), informed by Han and colleagues' taxonomy of uncertainty in clinical genomic sequencing, were conducted to assess motivations to pursue genetic testing, areas of perceived uncertainty, and strategies for managing uncertainty among 20 carriers of pathogenic variants in two moderate-risk genes, ATM and CHEK2. We found that participants pursue genetic testing with the expectation that results will clarify cancer risks and approaches to management. Participants experience uncertainties aligning with Han's taxonomy relating to the ambiguity of specific cancer risk estimates and effectiveness of certain risk management strategies. These uncertainties influenced decisions around the uptake of risk management strategies, which were additionally impacted by clinicians' uncertainty towards such strategies. Participants employ a variety of uncertainty management approaches to cope with their anxieties. Clinicians may wish to use these findings to facilitate patient adaptation to the implications of multigene panel testing for cancer susceptibility during both pre- and post-test counseling sessions.
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Affiliation(s)
- Kathryn G Reyes
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheyla Clark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Gerhart
- Cancer Genetics and Genomics, Stanford Health Care, Stanford, CA, USA
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA. .,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
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Reid S, Cragun D, Tezak A, Weidner A, Moore J, Mayer IA, Shu XO, Ye F, Fan R, Vadaparampil S, Pal T. Disparities in BRCA counseling across providers in a diverse population of young breast cancer survivors. Genet Med 2020; 22:1088-1093. [PMID: 32066870 PMCID: PMC7275890 DOI: 10.1038/s41436-020-0762-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE All women diagnosed with breast cancer (BC) ≤age 50 should be referred for genetic counseling (GC) and testing. We sought to compare differences in provider practices and access across a racially and ethnically diverse population of young BC survivors. METHODS A registry-based sample of women diagnosed with invasive BC ≤age 50 from 2009 to 2012 was recruited through the Florida Cancer Registry, and completed a questionnaire and medical record release. Differences were compared across those tested with or without the involvement of a board-certified or credentialed genetics health professional (GHP) in (1) clinical and demographic variables and (2) pretest GC elements. RESULTS Of 1622 participants, there were 440 Blacks, 285 Hispanics, and 897 Non-Hispanic Whites. Of 831 participants with medical record verification of testing provider, 170 (20%) had documentation of GHP involvement. Among the 613 who recalled a pretest discussion and had GC elements collected, those with GHP involvement were significantly more likely to recall the seven recognized GC elements. CONCLUSION GHP involvement was associated with adherence to nationally recommended best practices. With the expanding importance of identifying inherited cancers, it is critical to ensure equitable access to best practices across all populations.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Ann Tezak
- Vanderbilt University Medical Center, Nashville, TN
| | - Anne Weidner
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Xiao-ou Shu
- Vanderbilt University Medical Center, Nashville, TN
| | - Fei Ye
- Vanderbilt University Medical Center, Nashville, TN
| | - Run Fan
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, TN, USA.
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Kurian AW, Katz SJ. Emerging Opportunity of Cascade Genetic Testing for Population-Wide Cancer Prevention and Control. J Clin Oncol 2020; 38:1371-1374. [PMID: 32097078 DOI: 10.1200/jco.20.00140] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Allison W Kurian
- Departments of Medicine and Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Steven J Katz
- Departments of Health Management and Policy, School of Public Health, and Internal Medicine, University of Michigan, Ann Arbor, MI
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