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Hehmeyer KN, Zierhut H, Dedrick R, Dean M, Schwarting K, Bellia KS, Cragun D. The development and preliminary evaluation of the Genetic Counseling Skills Checklist. J Genet Couns 2024; 33:578-591. [PMID: 37529972 DOI: 10.1002/jgc4.1758] [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: 07/07/2021] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
Genetic counseling (GC) relies on communication to help people understand and adapt to genetic contributions of disease, and there is need for a practical and reliable method of comprehensively documenting GC communication skills without intensive coding. To this end, we created a novel process measure called the Genetic Counseling Skills Checklist (GCSC), utilizing previously validated measures, communication/counseling frameworks, and prior research findings. A multistage iterative process was used to develop, evaluate, and modify the GCSC to improve its clarity, usability, and content validity. To assess interrater reliability, randomly assigned, untrained individuals (i.e., coders) used the GCSC version 3 to code multiple simulated GC sessions. Average measures intraclass correlation coefficients (ICCs) were calculated for each of the 8 GCSC process categories using one-way, random effects models. After relatively minor modifications to the GCSC, two pairs of experienced coders used GCSC version 4 to independently code additional GC sessions and Cohen's Kappa coefficients (κ) were calculated to assess interrater reliability for each process category. The GCSC contains five to eight items within each category and demonstrates good content validity given its ability to capture nearly all GC skills that genetic counselors reported using in a prior qualitative study. Interrater reliability of GCSC version 3 among coders with limited experience was moderate or good for 6 out of the 8 process categories as evidenced by ICCs ranging from 0.55 to 0.86. Average interrater reliability of GCSC version 4 among one pair of experienced coders was strong for all eight process categories (κ ranging from 0.82 to 0.94); among the second pair of experienced coders scores were strong for six categories (κ ranging from 0.80 to 0.87) and moderate for two categories (κ of 0.77 and 0.78). The results suggest the need for training and experience to assure adequate interrater reliability across GCSC coders. Future work is needed to create a formalized training program for coders, complete a larger study to further validate the measure, and use the GCSC to document variability in skills used across providers and sessions.
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Affiliation(s)
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Robert Dedrick
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Katie Sullivan Bellia
- Orlando Health Winnie Palmer Hospital Center for Maternal Fetal Medicine, Orlando, Florida, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, Florida, USA
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2
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Likhanov M, Zakharov I, Awofala A, Ogundele O, Selita F, Kovas Y, Chapman R. Attitudes towards genetic testing: The role of genetic literacy, motivated cognition, and socio-demographic characteristics. PLoS One 2023; 18:e0293187. [PMID: 37967060 PMCID: PMC10651000 DOI: 10.1371/journal.pone.0293187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/26/2023] [Indexed: 11/17/2023] Open
Abstract
Understanding reasons for why people choose to have or not to have a genetic test is essential given the ever-increasing use of genetic technologies in everyday life. The present study explored the multiple drivers of people's attitudes towards genetic testing. Using the International Genetic Literacy and Attitudes Survey (iGLAS), we collected data on: (1) willingness to undergo testing; (2) genetic literacy; (3) motivated cognition; and (4) demographic and cultural characteristics. The 37 variables were explored in the largest to-date sample of 4311 participants from diverse demographic and cultural backgrounds. The results showed that 82% of participants were willing to undergo genetic testing for improved treatment; and over 73%-for research. The 35 predictor variables together explained only a small proportion of variance: 7%-in the willingness to test for Treatment; and 6%-for Research. The strongest predictors of willingness to undergo genetic testing were genetic knowledge and deterministic beliefs. Concerns about data misuse and about finding out unwanted health-related information were weakly negatively associated with willingness to undergo genetic testing. We also found some differences in factors linked to attitudes towards genetic testing across the countries included in this study. Our study demonstrates that decision-making regarding genetic testing is influenced by a large number of potentially interacting factors. Further research into these factors may help consumers to make decisions regarding genetic testing that are right for their specific circumstances.
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Affiliation(s)
- Maxim Likhanov
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Ilya Zakharov
- Ural Federal University Named after the First President of Russia B. N. Yeltsin, Yekaterinburg, Russia
- Psychological Institute of Russian Academy of Education, Moscow, Russia
| | - Adeyemi Awofala
- Department of Biological Sciences, Tai Solarin University of Education, Ijebu-Ode, Nigeria
| | - Olusegun Ogundele
- Department of Biological Sciences, Tai Solarin University of Education, Ijebu-Ode, Nigeria
| | - Fatos Selita
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Yulia Kovas
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Robert Chapman
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
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3
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Frijstein MM, Hamers SL, van Driel WJ, Bleiker EMA, van der Kolk L, Sijstermans R, Lok CAR. Effects of a pre-visit online information tool about genetic counselling for ovarian cancer patients, a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 113:107786. [PMID: 37148840 DOI: 10.1016/j.pec.2023.107786] [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: 01/17/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients. METHODS Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling. RESULTS The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed. CONCLUSION Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling. PRACTICE IMPLICATIONS Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - S L Hamers
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - W J van Driel
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - L van der Kolk
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Sijstermans
- Division of Informatics and Automatisation, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C A R Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands.
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4
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Swoboda CM, Wijayabahu AT, Fareed N. Attitudes towards and sociodemographic determinants of genetic test usage in the USA; data from the Health Information National Trend Survey, 2020. J Genet Couns 2023; 32:57-67. [PMID: 35908205 PMCID: PMC10087577 DOI: 10.1002/jgc4.1620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to examine the trends in who obtains genetic tests, and opinions about how genes affect health. Cross-sectional survey data from Health Information National Trends Survey (HINTS) 5, Cycle 4 was used. This data was collected from adults 18 years of age or older who completed mailed surveys sent by the National Cancer Institute between January and April 2020. The sample consisted of 2,947 respondents who answered the question 'Have you ever had a genetic test'? 727 had a test and 2,220 did not have a test. The measures used included survey questions that asked whether respondents obtained certain kinds of genetic tests, who they shared test results with, whether they believed genes affect health status, and their demographic and cancer status information. Multivariate logistic regression models were developed to assess which demographic variables were associated with having different kinds of genetic tests, and whether those who had genetic tests had different opinions about genetic testing and the influence of genes on health. We found that female respondents [OR: 1.9; CI: (1.2-3.1)] had higher odds of having any genetic tests while Hispanic [OR: 0.5; CI: (0.2-1.0)] respondents had lower odds. Our findings indicate that there are demographic disparities in who received genetic tests, and that cancer risk alone does not explain the differences in prevalence of genetic testing.
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Affiliation(s)
- Christine M Swoboda
- CATALYST- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akemi T Wijayabahu
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Kopel J, Brower GL. Perspectives on Consumer and Clinical Genetic Testing Education among Medical Students in West Texas. J Community Hosp Intern Med Perspect 2022; 12:28-32. [PMID: 35711394 PMCID: PMC9195083 DOI: 10.55729/2000-9666.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
There is a popular trend for genetic test companies to market genetic screenings to identify detrimental mutations directly to consumers. As a result, there has been an increase in the number of patients wanting to discuss the results of their personal genetic tests with their physician. In turn, the medical education community has recognized a need to provide medical staff and patients with resources to interpret and act on personal genetic data. Most medical students and residents lack the requisite knowledge to interpret and manage patient-provided individualized genetic testing. This has prompted a growing interest among medical students in learning more about genetic testing and how to counsel their patients on this information. Consequently, early educational exposure to clinical genetic testing and counseling would benefit medical education training programs. In this study, we examine the perceptions of medical students in West Texas with regard to clinical genetic testing.
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Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, TX,
USA
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Dwyer AA, Shen H, Zeng Z, Gregas M, Zhao M. Framing Effects on Decision-Making for Diagnostic Genetic Testing: Results from a Randomized Trial. Genes (Basel) 2021; 12:genes12060941. [PMID: 34202935 PMCID: PMC8234313 DOI: 10.3390/genes12060941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Genetic testing is increasingly part of routine clinical care. However, testing decisions may be characterized by regret as findings also implicate blood relatives. It is not known if genetic testing decisions are affected by the way information is presented (i.e., framing effects). We employed a randomized factorial design to examine framing effects on hypothetical genetic testing scenarios (common, life-threatening disease and rare, life-altering disease). Participants (n = 1012) received one of six decision frames: choice, default (n = 2; opt-in, opt-out), or enhanced choice (n = 3, based on the Theory of Planned Behavior). We compared testing decision, satisfaction, regret, and decision cognitions across decision frames and between scenarios. Participants randomized to ‘choice’ were least likely to opt for genetic testing compared with default and enhanced choice frames (78% vs. 83–91%, p < 0.05). Neither satisfaction nor regret differed across frames. Perceived autonomy (behavioral control) predicted satisfaction (B = 0.085, p < 0.001) while lack of control predicted regret (B = 0.346, p < 0.001). Opting for genetic testing did not differ between disease scenarios (p = 0.23). Results suggest framing can nudge individuals towards opting for genetic testing. These findings have important implications for individual self-determination in the genomic era. Similarities between scenarios with disparate disease trajectories point to possible modular approaches for web-based decisional support.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA
- Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-617-522-1711
| | - Hongjie Shen
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Ziwei Zeng
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Matt Gregas
- Department of Research Services, Boston College, Chestnut Hill, MA 02467, USA;
| | - Min Zhao
- Carroll School of Management, Boston College, Chestnut Hill, MA 02467, USA;
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7
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Christian S, Welsh A, Yetman J, Birch P, Bartels K, Burnell L, Curtis F, Huculak C, Zahavich L, Arbor L, Marcadier J, Atallah J. Development and evaluation of decision aids to guide families' predictive testing choices for children at risk for arrhythmia or cardiomyopathy. Can J Cardiol 2021; 37:1586-1592. [PMID: 34147624 DOI: 10.1016/j.cjca.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Accepted: 05/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assessing the issues surrounding predictive genetic testing for children at risk of an inherited arrythmia or cardiomyopathy is complex. The objective of this study was to design and evaluate four cardiac decision aids. The decision aids were developed to assist families with a genetic diagnosis of long QT syndrome, hypertrophic cardiomyopathy, dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy in deciding between predictive genetic testing and cardiac screening for their children. METHOD/RESULTS The decision aids were developed using the International Patient Decision Aid Standards framework and revised based on feedback from individuals with lived experience, genetic counsellors and other healthcare professionals. Response to the decision aids was positive and acceptability and understandability scores were high. CONCLUSION The decision aids can be used before, during or following a genetic counselling appointment as a resource or to guide discussion. These tools permit a balanced and consistent approach to the decision-making process, with a focus on the importance families place on the advantages and disadvantages of each option.
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Affiliation(s)
| | | | | | - Patrician Birch
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Bartels
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Fiona Curtis
- Eastern Health, St. John's, Newfoundland, Canada
| | | | | | - Laura Arbor
- University of British Columbia, Vancouver, British Columbia, Canada
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8
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Jujjavarapu C, Anandasakaran J, Amendola LM, Haas C, Zampino E, Henrikson NB, Jarvik GP, Mooney SD. ShareDNA: a smartphone app to facilitate family communication of genetic results. BMC Med Genomics 2021; 14:10. [PMID: 33407467 PMCID: PMC7788871 DOI: 10.1186/s12920-020-00864-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Genetic testing allows patients and clinicians to understand the risk of hereditary diseases. By testing early, individuals can make informed medical decisions about management which may minimize the risk of developing certain diseases. Importantly, genetic test results may also be applicable to patients' biological relatives; thus, these results could also lead to minimizing their risk of disease. However, sharing genetic test results between patients and their relatives is scarce. The most frequently reported problems are that patients cannot clearly explain this information and relatives misinterpret the results. Smartphone apps in the healthcare field are a possible solution as they allow patients to accurately share sensitive information to others, while providing educational material to support understanding the information. However, these apps may not provide security to protect patients' identifiable information. We developed ShareDNA, a smartphone app that (1) allows patients to securely share their genetic test results with others, (2) provides information on how to interpret these results, and (3) minimizes the amount of patient information needed to use the service. RESULTS We recruited thirteen participants to test the usability of our app and provide feedback. We found overall that participants were comfortable with using this app and could easily learn each app function when filling out our questionnaire. Additionally, based on vocalized impressions of the usefulness of the app, participants indicated that the user-interface could be more intuitive and that we needed to add more text within the app to explain why ShareDNA is a secure service. CONCLUSIONS ShareDNA is a free smartphone app that allows patients to share their genetic test results with others, including their biological relatives. Sharing these results along with educational material will enable relatives to share accurate information and discuss their possible risk for disease with their clinical providers. As a result, appropriate testing in relatives could be improved.
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Affiliation(s)
- Chethan Jujjavarapu
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeevan Anandasakaran
- Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Laura M Amendola
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
| | - Cameron Haas
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Elizabeth Zampino
- Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gail P Jarvik
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA.
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Bourdon JL, Davies RA, Long EC. Four Actionable Bottlenecks and Potential Solutions to Translating Psychiatric Genetics Research: An Expert Review. Public Health Genomics 2020; 23:171-183. [PMID: 33147585 PMCID: PMC7854816 DOI: 10.1159/000510832] [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: 03/23/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psychiatric genetics has had limited success in translational efforts. A thorough understanding of the present state of translation in this field will be useful in the facilitation and assessment of future translational progress. PURPOSE A narrative literature review was conducted. Combinations of 3 groups of terms were searched in EBSCOhost, Google Scholar, and PubMed. The review occurred in multiple steps, including abstract collection, inclusion/exclusion criteria review, coding, and analysis of included papers. RESULTS One hundred and fourteen articles were analyzed for the narrative review. Across those, 4 bottlenecks were noted that, if addressed, may provide insights and help improve and increase translation in the field of psychiatric genetics. These 4 bottlenecks are emphasizing linear translational frameworks, relying on molecular genomic findings, prioritizing certain psychiatric disorders, and publishing more reviews than experiments. CONCLUSIONS These entwined bottlenecks are examined with one another. Awareness of these bottlenecks can inform stakeholders who work to translate and/or utilize psychiatric genetic information. Potential solutions include utilizing nonlinear translational frameworks as well as a wider array of psychiatric genetic information (e.g., family history and gene-environment interplay) in this area of research, expanding which psychiatric disorders are considered for translation, and when possible, conducting original research. Researchers are urged to consider how their research is translational in the context of the frameworks, genetic information, and psychiatric disorders discussed in this review. At a broader level, these efforts should be supported with translational efforts in funding and policy shifts.
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Affiliation(s)
- Jessica L Bourdon
- Department of Psychiatry, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA,
| | - Rachel A Davies
- Yerkes National Primate Research Center, Division of Behavioral Neuroscience and Psychiatric Disorders, Emory University, Atlanta, Georgia, USA
| | - Elizabeth C Long
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania, USA
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10
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Underhill-Blazey M, Blonquist T, Chittenden A, Pozzar R, Nayak M, Lansang K, Hong F, Garber J, Stopfer JE. Informing models of cancer genetics care in the era of multigene panel testing with patient-led recommendations. J Genet Couns 2020; 30:268-282. [PMID: 32851753 DOI: 10.1002/jgc4.1317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The study describes patient-reported experiences and recommendations to improve the genetic counseling and multigene panel testing (MGPT) process. A descriptive mixed-method study with concurrently collected and integrated qualitative and quantitative data was conducted. Eligible participants were English-speaking adults with a breast or gynecologic cancer diagnosis who had received genetic counseling and testing with a MGPT from one Comprehensive Cancer Center. Satisfaction with the genetic counseling, genetic knowledge using a recently validated scale (KnowGene), the multidimensional impact of cancer risk assessment (MICRA), family communication, and the association with demographic factors were evaluated. To supplement the large quantitative data set, qualitative focus group responses and open-ended text items were collected. Univariate and multivariable associations between each outcome of interest and personal characteristics were assessed. Qualitative data were content-analyzed. 603 participants completed the survey (48% response rate) and 10 individuals participated in the focus groups. Participants were mostly Caucasian, educated with a college degree or more, and female with median age 58 (24-91), and 78% of participants had a breast cancer diagnosis. Of all individuals undergoing genetic testing using a MGPT, 13% had a pathogenic variant identified, and 30% had a variant of uncertain significance (VUS). Overall, participants reported satisfaction with the genetic counseling and testing process (mean 36.9 [SD 4.7]). On average, participants had 7 incorrect answers out of 19 on the genetic knowledge scale (mean 12.3 [SD 3.4]). MICRA scores showed overall low levels of distress and uncertainty, as well as positive experiences, with wide variability (median 17 [0-84]). Age, marital status, education level, type of cancer diagnosis, and genetic testing results were significantly associated with outcomes. Most participants communicated genetic testing results to mainly female first-degree relatives. A wide range of individual preferences affecting overall satisfaction, or suggestions for improvement were shared. As new models of streamlined cancer genetic services are being clinically implemented, approaches should continue to assess and tailor the process based on patients' informational and emotional needs.
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Affiliation(s)
- Meghan Underhill-Blazey
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA.,School of Nursing, University of Rochester, Rochester, NY, USA
| | - Traci Blonquist
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anu Chittenden
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manan Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristina Lansang
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy Garber
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jill E Stopfer
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
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Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening. Cancers (Basel) 2020; 12:cancers12082316. [PMID: 32824510 PMCID: PMC7464326 DOI: 10.3390/cancers12082316] [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: 06/15/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
Pathogenic germline variants in Breast Cancer 1/2 (BRCA) genes confer increased cancer risk. Understanding BRCA status/risk can enable family cascade screening and improve cancer outcomes. However, more than half of the families do not communicate family cancer history/BRCA status, and cancer outcomes differ according to parent of origin (i.e., maternally vs. paternally inherited pathogenic variant). We aimed to explore communication patterns around family cancer history/BRCA risk according to parent of origin. We analyzed qualitative interviews (n = 97) using template analysis and employed the Theory of Planned Behavior (TPB) to identify interventions to improve communication. Interviews revealed sub-codes of ‘male stoicism and ‘paternal guilt’ that impede family communication (template code: gender scripting). Conversely, ‘fatherly protection’ and ‘female camaraderie’ promote communication of risk. The template code ‘dysfunctional family communication’ was contextualized by several sub-codes (‘harmful negligence’, ‘intra-family ignorance’ and ‘active withdrawal of support’) emerging from interview data. Sub-codes ‘medical misconceptions’ and ‘medical minimizing’ deepened our understanding of the template code ‘medical biases’. Importantly, sub-codes of ‘informed physicians’ and ‘trust in healthcare’ mitigated bias. Mapping findings to the TPB identified variables to tailor interventions aimed at enhancing family communication of risk and promoting cascade screening. In conclusion, these data provide empirical evidence of the human factors impeding communication of family BRCA risk. Tailored, theory-informed interventions merit consideration for overcoming blocked communication and improving cascade screening uptake.
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12
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Thapa S, Leppin A, Kristensen R, Just Bonde M, Aro AR. Implementation of interventions targeting the uptake of genetic testing services for breast cancer risk: protocol for a systematic review. BMJ Open 2020; 10:e031727. [PMID: 32595144 PMCID: PMC7322324 DOI: 10.1136/bmjopen-2019-031727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The timely identification of breast cancer-related pathogenic variants can help to identify the risk of potential disease development and determine healthcare choices. However, the uptake rate of genetic testing services for breast cancer risk remains low in many countries. Interventions targeting the uptake of these services among individuals potentially at risk for inherited breast cancer are often complex and have multiple components, and are therefore difficult to implement, replicate and disseminate to new contexts. Our aim is to systematically review studies targeting the uptake of genetic testing services for breast cancer risk and critically assess the quality of implementation outcomes and the reporting of intervention descriptions. METHODS AND ANALYSIS PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and all Campbell Coordinating Group databases will be searched for intervention studies that target individuals' participation in breast cancer genetic testing programmes. Papers published in English within the time period from January 2005 until October 2019 will be considered for inclusion. Titles, abstracts and full papers will be screened for eligibility by two pairs of reviewers independently. For data analysis and synthesis, study-level and intervention-level characteristics will be abstracted. We will present all implementation outcomes that are mentioned in each of the studies and register the number of studies that do not at all look at or report implementation outcomes. The quality of implementation will be checked using a 5-point rubric item, and the quality and completeness of reporting of intervention description will be evaluated using the 12-item Template for Intervention Description and Replication (TIDieR). ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. Review findings will be disseminated to academic and non-specialist audiences via peer-reviewed academic journals and presented at appropriate conferences, workshops and meetings to policymakers, practitioners and organisations that work with our population of interest. PROSPERO REGISTRATION NUMBER CRD42018105732.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9, 5000 Odense, Denmark
| | - Anja Leppin
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Rikke Kristensen
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Mette Just Bonde
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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13
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A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer. Breast Cancer Res Treat 2020; 183:9-21. [PMID: 32577939 PMCID: PMC7376076 DOI: 10.1007/s10549-020-05741-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Purpose This systematic review examined educational training interventions for healthcare professionals (HCPs) discussing genetic testing and risk for hereditary breast cancer. There was a particular focus on the presence, and content, of communication elements within these packages. Methods Searches were run via CINAHL, EMBASE, PUBMED, and PsychInfo in February 2019 to identify training interventions available to HCPs with reference to communication skills. Studies were assessed for quality, with relevant intervention and outcome data extracted and synthesized. This review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement and was registered on the PROSPERO database (CRD42019124010). Results Of 3,988 items, seven papers, two of which were linked, were eligible for inclusion. There was a mix of randomized and single arm studies with web-based and face-to-face interventions. Content included an overview of genetics, hereditary and familial background, and recommended practice techniques. Outcomes focused on communication, self-efficacy, knowledge, and satisfaction. Interventions were designed for genetic counselors, physicians, primary care physicians (PCPs), medical students, and nurses. None of the papers featured oncologists or surgeons. Conclusions This review revealed an overall lack of publications which evaluated interventions to assist HCPs discussing hereditary breast cancer risk and testing. Studies failed to operationalize which ‘communication skills’ they included, nor did they consistently report randomization, outcome measures, or analysis. Discussing the need for, and management of, genetic testing for inherited cancer risk with individuals and their families can be challenging. As genetic testing in breast cancer becomes more common, the provision of specific communication-based training programs, with reference to genetic testing, risk assessments, and counseling skills is warranted. Electronic supplementary material The online version of this article (10.1007/s10549-020-05741-z) contains supplementary material, which is available to authorized users.
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14
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Clinical Decision Support Systems in Breast Cancer: A Systematic Review. Cancers (Basel) 2020; 12:cancers12020369. [PMID: 32041094 PMCID: PMC7072392 DOI: 10.3390/cancers12020369] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women, with more than 2.1 million new diagnoses worldwide every year. Personalised treatment is critical to optimising outcomes for patients with breast cancer. A major advance in medical practice is the incorporation of Clinical Decision Support Systems (CDSSs) to assist and support healthcare staff in clinical decision-making, thus improving the quality of decisions and overall patient care whilst minimising costs. The usage and availability of CDSSs in breast cancer care in healthcare settings is increasing. However, there may be differences in how particular CDSSs are developed, the information they include, the decisions they recommend, and how they are used in practice. This systematic review examines various CDSSs to determine their availability, intended use, medical characteristics, and expected outputs concerning breast cancer therapeutic decisions, an area that is known to have varying degrees of subjectivity in clinical practice. Utilising the methodology of Kitchenham and Charter, a systematic search of the literature was performed in Springer, Science Direct, Google Scholar, PubMed, ACM, IEEE, and Scopus. An overview of CDSS which supports decision-making in breast cancer treatment is provided along with a critical appraisal of their benefits, limitations, and opportunities for improvement.
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15
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Morgan S, Hanna J, Yousef GM. Knowledge Translation in Oncology: The Bumpy Ride From Bench to Bedside. Am J Clin Pathol 2020; 153:5-13. [PMID: 31836881 DOI: 10.1093/ajcp/aqz099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Knowledge translation (KT) is the dynamic process of mobilizing best-practice evidence to guide health care decisions. METHODS Using a PubMed search, challenges were identified and milestones defined. RESULTS Substantial challenges exist in integrating discoveries into patient care, including technical limitations related to genomic testing like turnaround time, standardization, reproducibility, and results interpretation. Other challenges include lack of proper training in genetic counseling for health care providers, clarity of scientific evidence, and ethical, legal and social considerations. In addition, most health care systems lack accessibility to genetic testing services. Moving forward, KT should be addressed at three main frontiers. The first is patients centered for proper understanding and decision making; the second is directed toward health care professionals, including clinical decision support and clarity of roles; and the third addresses resources of health care systems. CONCLUSIONS Implementing KT requires developing strategies to enhance awareness and promote behavioral changes congruent with research evidence, designing a systematic approach by health care providers and stakeholders to achieve patient-centered care.
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Affiliation(s)
- Sarah Morgan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Jessica Hanna
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - George M Yousef
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada
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16
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Veilleux S, Bouffard M. Knowledge and understanding of pharmacogenomic testing among patients and health care professionals: A scoping review. PATIENT EDUCATION AND COUNSELING 2019; 102:2001-2009. [PMID: 31229328 DOI: 10.1016/j.pec.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To support the introduction of pharmacogenomic tests in current practice, this study identifies the factors associated with a better understanding of the information related to genetic, genomic and/or pharmacogenomic tests by patients and health care professionals. METHODS Following a scoping review methodology, a search for literature was conducted with keywords related to health literacy and knowledge translation in the context of pharmacogenomic tests. Since only 6 articles were identified, the context of genetic or genomic testing were added to the inclusion criteria, leading to 24 articles. RESULTS Fourteen of the studies analyzed focused on genetic predictive, diagnostic or carrier tests, or concerned genetics in general, while ten addressed or included the use of pharmacogenomic tests. Demographic, individual, experiential and contextual factors were associated with a better understanding of the information related to genetic, genomic and/or pharmacogenomic tests among the targeted populations. RESEARCH IMPLICATIONS Our review shows that there is currently little empirical research available to identify the factors to consider in order to develop educational tools and resources specific to pharmacogenomics. CONCLUSION Expanding our review to include genetic and genomic testing factors can serve as a starting point for the evidence to be validated in future empirical research.
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Affiliation(s)
- Sophie Veilleux
- Department of Management, FSA ULaval - Business School, 2325, rue de la Terrasse, Pavillon Palasis-Prince, office 0533, Université Laval, Québec, Québec, G1V 0A6, Canada.
| | - Maud Bouffard
- FSA ULaval - Business School, 2325, rue de la Terrasse, Pavillon Palasis-Prince, Université Laval, Québec, Québec, G1V 0A6, Canada.
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Underhill-Blazey M, Stopfer J, Chittenden A, Nayak MM, Lansang K, Lederman R, Garber J, Gundersen DA. Development and testing of the KnowGene scale to assess general cancer genetic knowledge related to multigene panel testing. PATIENT EDUCATION AND COUNSELING 2019; 102:1558-1564. [PMID: 31010603 DOI: 10.1016/j.pec.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To develop and evaluate a measure of cancer genetics knowledge relevant to multigene panel testing. METHODS The instrument was developed using systematic input from a national panel of genetics experts, acceptability evaluation by patient advocates, and cognitive testing. Twenty-four candidate items were completed by 591 breast or gynecological patients who had undergone genetic counseling and multigene panel testing in the past 18 months. A unidimensional item response theory model was fit with a mix of 2-parameter logistic nested response (2 plnrm) and 2-parameter logistic (2 pl) items. RESULTS Key domains addressing cancer genetics knowledge were found to be overlapping. Of the 24 candidate items, 8 items were removed due to poor discrimination or local dependence. The remaining 16 items had good fit (RMSEA = 0.045, CFI = 0.946) and discrimination parameters ranging from 0.49 to 1.60. The items specified as 2 plnrm distinguish between those answering incorrect versus don't know, with discrimination ranging from 0.51 to 1.02. Information curves were highest among those with lower knowledge. CONCLUSION KnowGene is a rigorously developed and effective measure of knowledge after cancer genetic counseling and multigene panel testing. PRACTICE IMPLICATIONS Measuring knowledge in a systematic way will inform practice and research initiatives in cancer genetics.
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Affiliation(s)
| | - Jill Stopfer
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Anu Chittenden
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Manan M Nayak
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Kristina Lansang
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Ruth Lederman
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Judy Garber
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
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18
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Kopel J. Clinical genetic testing in medical education. Proc (Bayl Univ Med Cent) 2019; 32:165-166. [DOI: 10.1080/08998280.2018.1528937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting. BMC Med Inform Decis Mak 2018; 18:134. [PMID: 30558581 PMCID: PMC6296071 DOI: 10.1186/s12911-018-0716-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023] Open
Abstract
Background Breast cancer chemoprevention can reduce breast cancer incidence in high-risk women; however, chemoprevention is underutilized in the primary care setting. We conducted a pilot study of decision support tools among high-risk women and their primary care providers (PCPs). Methods The intervention included a decision aid (DA) for high-risk women, RealRisks, and a provider-centered tool, Breast Cancer Risk Navigation (BNAV). Patients completed validated surveys at baseline, after RealRisks and after their PCP clinical encounter or at 6-months. Referral for high-risk consultation and chemoprevention uptake were assessed via the electronic health record. The primary endpoint was accuracy of breast cancer risk perception at 6-months. Results Among 40 evaluable high-risk women, median age was 64.5 years and median 5-year breast cancer risk was 2.19%. After exposure to RealRisks, patients demonstrated an improvement in accurate breast cancer risk perceptions (p = 0.02), an increase in chemoprevention knowledge (p < 0.01), and 24% expressed interest in taking chemoprevention. Three women had a high-risk referral, and no one initiated chemoprevention. Decisional conflict significantly increased from after exposure to RealRisks to after their clinical encounter or at 6-months (p < 0.01). Accurate breast cancer risk perceptions improved and was sustained at 6-months or after clinical encounters. We discuss the side effect profile of chemoprevention and the care pathway when RealRisks was introduced to understand why patients experienced increased decision conflict. Conclusion Future interventions should carefully link the use of a DA more proximally to the clinical encounter, investigate timed measurements of decision conflict and improve risk communication, shared decision making, and chemoprevention education for PCPs. Additional work remains to better understand the impact of decision aids targeting both patients and providers. Trial registration ClinicalTrials.gov Identifier: NCT02954900 November 4, 2016 Retrospectively registered.
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Silverman TB, Kuperman GJ, Vanegas A, Sin M, Dimond J, Crew KD, Kukafka R. An Applied Framework in Support of Shared Decision Making about BRCA Genetic Testing. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:961-969. [PMID: 30815139 PMCID: PMC6371283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The United States Preventive Services Taskforce recommends that primary care providers screen patients for an increased risk of carrying a BRCA1 or BRCA2 mutation and refer those who meet family history criteria to genetic counseling. Such screening requires detailed and accurate family history data, which often goes uncollected during a primary care visit due to time constraints, competing priorities, and lack of awareness on behalf of both patients and providers. In order to address these barriers and promote appropriate genetic counseling referral, we developed a user-centered framework that collects and communicates relevant data in order to prepare patients and their primary care providers for an informed discussion on genetic counseling referral. This paper describes this framework and the underlining data schema that makes it possible.
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Affiliation(s)
| | - Gilad J Kuperman
- Department of Biomedical Informatics, Columbia University, New York, NY
- Information Systems, NewYork-Presbyterian, New York, NY
| | - Alejandro Vanegas
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Margaret Sin
- Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - Katherine D Crew
- Department of Medicine, Columbia University, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Lewis MA, Bonhomme N, Bloss CS. A New Era, New Strategies: Education and Communication Strategies to Manage Greater Access to Genomic Information. Hastings Cent Rep 2018; 48 Suppl 2:S25-S27. [PMID: 30133727 PMCID: PMC6890375 DOI: 10.1002/hast.880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As next-generation genomic sequencing, including whole-genome sequencing information, becomes more common in research, clinical, and public health contexts, there is a need for comprehensive communication strategies and education approaches to prepare patients and clinicians to manage this information and make informed decisions about its use, and nowhere is that imperative more pronounced than when genomic sequencing is applied to newborns. Unfortunately, in-person counseling is unlikely to be applicable or cost-effective when parents obtain genomic risk information directly via the Internet. As a rule, communication strategies should match how people are accessing health information. Today, many people can obtain health information in a variety of settings, including through direct-to-consumer services, via websites, and through other digital channels or settings. In response to these changes, new communication strategies need to be considered. Adopting a comprehensive communication model means understanding the multiple levels of influence experienced by parents and the clinicians who serve them. In addition, applying communication-science principles can help in addressing some key challenges to effectively communicating genomic information to parents.
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Bombard Y, Clausen M, Mighton C, Carlsson L, Casalino S, Glogowski E, Schrader K, Evans M, Scheer A, Baxter N, Hamilton JG, Lerner-Ellis J, Offit K, Robson M, Laupacis A. The Genomics ADvISER: development and usability testing of a decision aid for the selection of incidental sequencing results. Eur J Hum Genet 2018; 26:984-995. [PMID: 29703952 PMCID: PMC6018661 DOI: 10.1038/s41431-018-0144-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023] Open
Abstract
Guidelines recommend patients be informed of their incidental results (IR) when undergoing genomic sequencing (GS), yet there are limited tools to support patients' decisions about learning IR. The aim of this study is to develop and test the usability of a decision aid (DA) to guide patients' selection of IR, and to describe patients' preferences for learning IR following use of the DA. We developed and evaluated a DA using an iterative, mixed-methods process consisting of (1) prototype development, (2) feasibility testing, (3) cognitive interviews, (4) design and programming, and (5) usability testing. We created an interactive online DA called the Genomics ADvISER, a genomics decision AiD about Incidental SEquencing Results. The Genomics ADvISER begins with an educational whiteboard video, and then engages users in a values clarification exercise, knowledge quiz and final choice step, based on a 'binning' framework. Participants found the DA acceptable and intuitive to use. They were enthusiastic towards GS and IR; all selected multiple categories of IR. The Genomics ADvISER is a new patient-centered tool to support the clinical delivery of incidental GS results. The Genomics ADvISER fills critical care gaps, given the health care system's limited genomics expertise and capacity to convey the large volume of IR and their myriad of implications.
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Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - Marc Clausen
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | - Selina Casalino
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | | | | | - Michael Evans
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Adena Scheer
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nancy Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Cancer Care Ontario, Toronto, ON, Canada
| | | | - Jordan Lerner-Ellis
- Mount Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Laupacis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
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Paul JL, Leslie H, Trainer AH, Gaff C. A theory-informed systematic review of clinicians' genetic testing practices. Eur J Hum Genet 2018; 26:1401-1416. [PMID: 29891880 DOI: 10.1038/s41431-018-0190-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022] Open
Abstract
This systematic literature review investigates factors impacting on clinicians' decisions to offer genetic tests in their practice, and maps them to a theoretical behaviour change framework. Better understanding of these factors will inform the design of effective interventions to integrate genomics tests into clinical care. We conducted a narrative synthesis of empirical research of medical specialists' perspectives on and experiences of offering genetic tests to their patients. This review was based upon the PRISMA statement and guidelines for reviewing qualitative research. Four electronic data sources were searched-MEDLINE, EMBASE, CINAHL, PubMed. Studies were independently assessed by two authors. Content analysis was applied to map the findings of included studies to a framework validated for behaviour and implementation research, the Theoretical Domains Framework (TDF). The TDF describes 14 factors known to influence behaviour and has been applied in diverse clinical settings to understand and/or modify health professional behaviour. Thirty-four studies published in 39 articles met inclusion and quality criteria. Most studies were published after 2011 (54%), Northern American (82%), quantitative in design (68%) and addressed familial cancer genetic tests (53%). Of the 14 TDF factors, 13 were identified. The three most common factors were: Environmental Context and Resources (n = 33), Beliefs about Consequences (n = 26), and Knowledge (n = 23). To support the adoption of genomic tests beyond specialist services, nuanced interventions targeting considerations beyond clinician education are needed. For instance, interventions addressing organisational constraints which may restrict clinicians' ability to offer genomic tests are required alongside those targeting factors intrinsic to the clinician.
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Affiliation(s)
- Jean L Paul
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Hanna Leslie
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Paediatric & Reproductive Unit, SA Clinical Genetics Service, Adelaide, South Australia, Australia
| | - Alison H Trainer
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Parkville integrated Familial Cancer Centre and Genomic Medicine, Peter McCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, VIC, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, Melbourne, VIC, Australia. .,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia. .,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia.
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