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Hay JL, Wu Y, Schofield E, Kaphingst K, Sussman AL, Guest DD, Hunley K, Li Y, Buller D, Berwick M. Exploring the role of cancer fatalism and engagement with skin cancer genetic information in diverse primary care patients. Psychooncology 2024; 33:e6331. [PMID: 38546209 DOI: 10.1002/pon.6331] [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: 07/19/2023] [Revised: 01/29/2024] [Accepted: 03/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To broaden the currently limited reach of genomic innovations, research is needed to understand how psychosocial and cultural factors influence reactions to genetic testing in diverse subgroups. Cancer fatalism is important in cancer prevention and deserves theoretical and empirical attention in the context of genomics and behavior change. METHODS The current study employed data from a randomized controlled trial (N = 593) offering skin cancer genetic testing (using the melanocortin-1 receptor [MC1R] gene) in primary care in Albuquerque, New Mexico, USA. We examined interrelations of cancer fatalism with demographics, general health beliefs, perceived risk, perceived control, sun protection and skin screening behaviors and cancer worry in the skin cancer context stratified across Hispanic versus non-Hispanic ethnicity, and examined cancer fatalism as a moderator of intervention effects on study primary outcomes, including 3-month sun protection, cancer worry and perceived risk. RESULTS Cancer fatalism was significantly related to the perception of control over skin cancer risk behaviors (ps ≤ 0.01) and demographics (ethnicity, education, health literacy; ps < 0.05), but not consistently related to general health beliefs or risk perception. Cancer fatalism did not moderate intervention effects on primary outcomes, except those with higher cancer fatalism randomized to intervention had higher levels of 3-month cancer worry (p = 0.019). CONCLUSIONS These findings will guide future work considering the role of cancer fatalism in use of genomic technologies in the general population. This work anticipates strategies required to address cancer fatalism as translational genomics becomes more commonly available to diverse general population subgroups.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kim Kaphingst
- Cancer Communication Research, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Delores D Guest
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Keith Hunley
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico, USA
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2
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Kaphingst KA, Bather JR, Daly BM, Chavez-Yenter D, Vega A, Kohlmann WK. Interest in Cancer Predisposition Testing and Carrier Screening Offered as Part of Routine Healthcare Among an Ethnically Diverse Sample of Young Women. Front Genet 2022; 13:866062. [PMID: 35495140 PMCID: PMC9047995 DOI: 10.3389/fgene.2022.866062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
Sequencing technologies can inform individuals’ risks for multiple conditions, supporting population-level screening approaches. Prior research examining interest in genetic testing has not generally examined the context of population-based approaches offered in routine healthcare or among ethnically diverse populations. Cancer predisposition testing and carrier screening could be offered broadly to women of reproductive age. This study therefore examined interest in these tests when offered as part of routine care, and predictors of interest, among an ethnically diverse sample of women aged 20–35. We conducted an online English-language survey of 450 women; 39% identified as Latina. We examined predictors of interest for two outcomes, interest in testing in the next year and level of interest, in multivariable logistic regression models and stratified analyses by Latina ethnicity. More than half of respondents reported being interested in cancer predisposition testing (55%) and carrier screening (56%) in the next year; this did not differ by ethnicity. About 26% reported being very interested in cancer predisposition testing and 27% in carrier screening. Latina respondents (32%) were more likely to be very interested in cancer predisposition testing than non-Latina respondents (22%; p < 0.03). In multivariable models, having higher worry about genetic risks, higher genetic knowledge, and higher perceived importance of genetic information were associated with higher interest across multiple models. Predictors of interest were generally similar by ethnicity. Our findings show substantial interest in both cancer predisposition testing and carrier screening among young women as part of routine healthcare with similar interest between Latina and non-Latina women. Efforts to broadly offer such testing could be important in improving access to genetic information. It will be critical to develop tools to help healthcare providers communicate about genetic testing and to address the needs of those who have less prior knowledge about genetics to support informed decision making.
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Affiliation(s)
- Kimberly A. Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Kimberly A. Kaphingst,
| | - Jemar R. Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Alexis Vega
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Wendy K. Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
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3
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Docherty A, Kious B, Brown T, Francis L, Stark L, Keeshin B, Botkin J, DiBlasi E, Gray D, Coon H. Ethical concerns relating to genetic risk scores for suicide. Am J Med Genet B Neuropsychiatr Genet 2021; 186:433-444. [PMID: 34472199 PMCID: PMC8692426 DOI: 10.1002/ajmg.b.32871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/02/2023]
Abstract
Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.
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Affiliation(s)
- Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Brent Kious
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Teneille Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Leslie Francis
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Louisa Stark
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Genetic Science Learning Center, University of Utah, Salt Lake City, UT USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT USA
| | - Jeffrey Botkin
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Doug Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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4
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"Being proactive, not reactive": exploring perceptions of genetic testing among White, Latinx, and Pacific Islander Populations. J Community Genet 2021; 12:617-630. [PMID: 34415555 DOI: 10.1007/s12687-021-00542-3] [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: 11/04/2020] [Accepted: 07/25/2021] [Indexed: 12/20/2022] Open
Abstract
Genetic testing is becoming an integral part of healthcare, but evidence suggests that both race and ethnicity influence access to and utilization of genetic testing. Given this barrier, data are needed on the perceptions of genetic testing in racial and ethnic minority groups. The purpose of this study was to explore the perceptions of three types of genetic testing (genetic testing for adult-onset conditions, prenatal screening, and newborn screening) in a sample of US participants who identified as White, Pacific Islander, and Latinx (10 dyads from each group for 60 participants total). Data were collected through semi-structured dyadic interviews and assessed using thematic analysis. The major themes were knowledge as empowering, knowledge as stressful, and predictive nature of prenatal testing and newborn screening. Some differences were seen in themes by race and ethnicity. A sense of collective and familial health appeared to be a more important theme for Pacific Islander and Latinx participants compared to White participants. Adult-onset genetic testing was viewed variously across all groups with some noting how it may increase anxiety, particularly if the disease screened for was unable to be prevented with action. All three groups reported on the positives of prenatal testing and newborn screening yet often were confused on the differences between them. This study presents novel perceptions of genetic testing in participants from diverse communities across three types of genetic testing. Genetic healthcare providers should incorporate participants' perceptions, values, and beliefs into their counseling delivery as a way to engage with diverse communities.
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5
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Lumpkins CY, Philp A, Nelson KL, Miller LM, Greiner KA. A road map for the future: An exploration of attitudes, perceptions, and beliefs among African Americans to tailor health promotion of cancer-related genetic counseling and testing. J Genet Couns 2020; 29:518-529. [PMID: 32291871 DOI: 10.1002/jgc4.1277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/30/2023]
Abstract
African Americans (AA), the second largest racial/ethnic minority group in the United States (US), carry the largest mortality burden of cancer compared with other racial/ethnic groups (Cancer Facts & Figures for African Americans, 2019-2021, American Cancer Society).One solution to address this disparity is through cancer-related genetic counseling and testing (CGT). Although CGT is utilized among the general population, it remains underutilized among AA populations. Community-engaged and community-driven health promotion programs within faith-based organizations (FBOs) have been successfully implemented and delivered among AA populations (Israel et al., American Journal of Public Health, 100, 2010, 2094). FBOs are well positioned for cancer-related health promotion and equipped as conduits of health education and information distribution for cancer prevention. In the present pilot study, a community-based participatory approach (CBPR) was used to collect exploratory data on attitudes, perceptions, and beliefs toward CGT and uptake among an AA sample in the Midwest. Focus groups were conducted in two churches where respondents (N=34) answered a pre-focus group survey prior to a discussion. Respondents were largely unaware of CGT and thought of testing as primarily for ancestral discovery and not for an inheritable disease. Themes identified through qualitative analysis included emotional experiences with cancer; perception of cancer risk; different pictures of genetic testing; other things to worry about; trust in the healthcare system/faith in God and the healthcare system; and ideas and insights regarding promotion of CGT. These primary themes showed participants' perceptions of CGT were shaped by their experiences with cancer, faith, faith communities/FBOs, and cost and access to CGT. Overall, participants within these organizations had positive perceptions about the church as a conduit of genetic testing information but had mixed opinions about the rationale for completing CGT. These findings have implications for genetic counselors, medical providers, and health promotion personnel as to how AA faith populations view CGT and the utility of FBOs as promoters of CGT information.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Family Medicine and Community Health, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Alisdair Philp
- Department of Internal Medicine, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Katherine L Nelson
- Department of Internal Medicine, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Lynn M Miller
- Faith Works Connecting for a Healthy Community Advisory Board, Kansas City, Kansas
| | - Keith Allen Greiner
- Department of Family Medicine and Community Health, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
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6
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Waltz M, Meagher KM, Henderson GE, Goddard KA, Muessig K, Berg JS, Weck KE, Cadigan RJ. Assessing the implications of positive genomic screening results. Per Med 2020; 17:101-109. [PMID: 32125936 PMCID: PMC7147673 DOI: 10.2217/pme-2019-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: Before population screening of ‘healthy’ individuals is widely adopted, it is important to consider the harms and benefits of receiving positive results and how harms and benefits may differ by age. Subjects & methods: Participants in a preventive genomic screening study were screened for 17 genes associated with 11 conditions. We interviewed 11 participants who received positive results. Results: Interviewees expressed little concern about their positive results in light of their older age, the risk condition for which they tested positive, or other pressing health concerns. Conclusion: Researchers and clinicians should recognize that returning positive results may not have the impact they presume given the diversity of the conditions screened and those who choose to undergo screening.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Karen M Meagher
- Department of Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Gail E Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Katrina Ab Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Kristin Muessig
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Karen E Weck
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.,Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - R Jean Cadigan
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.,UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
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7
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Hay JL, Meyer White K, Sussman A, Kaphingst K, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Zielaskowski K, Li Y, Buller D, Hunley K, Berwick M. Psychosocial and Cultural Determinants of Interest and Uptake of Skin Cancer Genetic Testing in Diverse Primary Care. Public Health Genomics 2019; 22:58-68. [PMID: 31437847 DOI: 10.1159/000501985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Translational research in genomics has limited reach and requires efforts to broaden access and utility in diverse populations. Skin cancer is common and rates are rising, including among Hispanics. Germline variants in the melanocortin-1 receptor (MC1R) gene are common in the population and confer moderate risk for melanoma and basal cell cancers across skin types. Feedback about MC1R risk status may promote skin cancer risk awareness and risk reduction. AIMS We examined the level of interest in pursuing MC1R testing, and patterns of interest across skin cancer perceived threat and control attitudes, cultural beliefs (family influence on health, health system distrust, cancer fatalism, skin cancer misconceptions), and health literacy. METHODS We used a study website to inform primary care patients in Albuquerque, NM about the benefits and drawbacks of MC1R testing. Website logon, request of a saliva test kit, and return of the test kit (yes vs. no) were primary assessments of study interest and uptake. RESULTS Of 499 participants provided with a test offer, 33% requested and returned the test. Lower family influence on participants' health was an important factor both overall and within ethnicity subgroups, and may indicate that primary care patients interested in skin cancer genetic testing see themselves as proactive health seekers, independent from family encouragement. Lower self-efficacy for skin cancer prevention was also an important characteristic of those who tested. CONCLUSION As evidence for common genetic markers for skin cancer accumulates, these findings suggest characteristics of those most likely to pursue genetic testing for skin cancer risk.
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Affiliation(s)
- Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, New York, New York, USA,
| | | | | | - Kim Kaphingst
- Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
| | - Dolores Guest
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Erika Robers
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Keith Hunley
- University of New Mexico, Albuquerque, New Mexico, USA
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8
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Williams JK, Bonham VL, Wicklund C, Coleman B, Taylor JY, Cashion AK. Advocacy and actions to address disparities in access to genomic health care: A report on a National Academies workshop. Nurs Outlook 2019; 67:605-612. [PMID: 31395393 DOI: 10.1016/j.outlook.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/17/2019] [Accepted: 06/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the United States, access to genomic risk assessment, testing, and follow up care is most easily obtained by those who have sufficient financial, educational, and social resources. Multiple barriers limit the ability of populations without those resources to benefit from health care that integrates genomics in assessment of disease risk, diagnosis, and targeted treatment. PURPOSE To summarize barriers and potential actions to reduce genomic health care disparities. METHOD Summarize authors' views on discussions at a workshop hosted by the National Academy of Medicine. DISCUSSION Barriers include access to health care providers that utilize genomics, genetic literacy of providers and patients, and absence of evidence of gene variants importance in ancestrally diverse underserved populations. CONCLUSION Engagement between underserved communities, health care providers, and policy makers is an essential component to raise awareness and seek solutions to barriers in access to genomic health care for all populations.
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Affiliation(s)
- Janet K Williams
- College of Nursing, The University of Iowa, Iowa City, IA; American Academy of Nursing, Washington, DC.
| | - Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | | | - Bernice Coleman
- American Academy of Nursing, Washington, DC; Cedars-Sinai, Los Angeles, CA
| | - Jacquelyn Y Taylor
- American Academy of Nursing, Washington, DC; New York University Rory Meyers College of Nursing, New York, NY
| | - Ann K Cashion
- American Academy of Nursing, Washington, DC; National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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9
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Kaphingst KA, Peterson E, Zhao J, Gaysynsky A, Elrick A, Hong SJ, Krakow M, Pokharel M, Ratcliff CL, Klein WMP, Khoury MJ, Chou WYS. Cancer communication research in the era of genomics and precision medicine: a scoping review. Genet Med 2019; 21:1691-1698. [PMID: 30573799 PMCID: PMC7725534 DOI: 10.1038/s41436-018-0402-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 01/13/2023] Open
Abstract
Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010-2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.
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Affiliation(s)
- Kimberly A Kaphingst
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Communication, University of Utah, Salt Lake City, UT, USA.
| | | | | | | | - Ashley Elrick
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Soo Jung Hong
- National University of Singapore, Singapore, Singapore
| | | | | | - Chelsea L Ratcliff
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | | | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Alharbi AA, Shaqran TM, Eltobgy AAEL, Albalawi AR, Alnawmasi WS. Physicians' Perspective on Diabetes Mellitus Management within the Context of Personalized Medicine Era in Tabuk Governorate, Saudi Arabia. Open Access Maced J Med Sci 2019; 7:1706-1711. [PMID: 31210827 PMCID: PMC6560294 DOI: 10.3889/oamjms.2019.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND: Minimizing the number of therapy failures and decreasing the diabetic complications can be achieved by the application of personalising diabetes therapy, based on patient`s genetics, however, currently, personalised Medicine (PM) in diabetes mellitus management is not extensively applied. AIM: To assess the knowledge, attitudes, and willingness of physicians in practising of PM in diabetes management. METHODS: A cross-sectional analytical study was implemented among 126 physicians from six different governmental hospitals and 12 primary care centres selected by the stratified random sampling technique in the Tabuk region of Saudi Arabia. A structured self-administered questionnaire was utilised for data collection. A simple scoring system (scale of 5 points) was utilised to assess knowledge and willingness. Likert scale was applied to evaluate the attitudes towards practising PM in DM management by the fixed choice response formats. RESULTS: The majority of the participants (97.62%) claimed not receiving any PM and/or genomic medicine training. Most of them (82.54%) expressed unsatisfactory knowledge concerning personalised DM, whereas the medium level of attitudes was reported among 57.14% of them and a good level of willingness had been observed among 76.98% of the physicians. CONCLUSION: Emphasizing on essential personalised DM management knowledge aspects should be given a considerable priority. Fortunately, positive attitudes and goodwill of physicians towards PM are encouraging and should be supported by policymakers.
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Affiliation(s)
- Asma Ali Alharbi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
| | | | - Ahmed Abu ELfoutoh Eltobgy
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Waad Saad Alnawmasi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
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11
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Turbitt E, Roberts MC, Hollister BM, Lewis KL, Biesecker LG, Klein WMP. Ethnic identity and engagement with genome sequencing research. Genet Med 2018; 21:1735-1743. [PMID: 30568309 PMCID: PMC6586548 DOI: 10.1038/s41436-018-0410-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose. We examined the role of ethnic identity (which measures the degree to
which individuals identify with their ethnic group) in beliefs about, and
intentions to learn, genomic results. Methods. A longitudinal cohort was recruited to implement genome sequencing
among healthy participants self-identifying as African, African-American, or
Afro-Caribbean, 40–65 years old (n=408). Before
receiving genomic results, participants completed a survey assessing social
and behavioral constructs related to health, genomics, and ethnic
identity. Results. Ethnic identity was positively correlated with perceived value of
genomic results and expected benefits from genomic research participation.
Among participants with stronger ethnic identity, cognitive beliefs
[perceived value of results (b=0.63, 95% CI: 0.29, 0.98,
p<0.001) and expected benefits from genomic
research participation (b=0.32, 95% CI: 0.12, 0.53,
p=0.002)] were associated with intentions to receive
results. Among those with weaker ethnic identity, there was no such
association. Conclusion. Individuals with stronger ethnic identity seem to attend more to
cognitive beliefs such as the value of genomic results when deliberating
receipt of results compared to those with weaker ethnic identity.
Understanding ethnic identity variation and its influence on genome
sequencing perceptions and intentions can inform future research
opportunities using ethnic identity to explore specific practical, clinical
questions.
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Affiliation(s)
- Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA. .,Bioethics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Megan C Roberts
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brittany M Hollister
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, MD, USA
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, MD, USA
| | - William M P Klein
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Carcioppolo N, Christy KR, Jensen JD, King AJ, Goonewardene J, Raftery D. Biomarker profiling for breast cancer detection: translational research to determine acceptance of a novel breast cancer screening technique. Health Syst (Basingstoke) 2018; 8:44-51. [PMID: 31214353 DOI: 10.1080/20476965.2017.1414740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/29/2017] [Accepted: 11/25/2017] [Indexed: 10/26/2022] Open
Abstract
The current study seeks to determine how the psychosocial predictors of the health belief model are related to willingness to adopt biomarker screening practices among women above and below current screening age recommendations, as biomarker profiling can potentially detect cancer much earlier than current breast cancer detection methods. Patients (N = 205) at an Obstetrician/Gynaecology office in a mid-sized Midwest city. Participants completed a survey in the waiting room before their doctor appointment. Results revealed that benefits (p < .001), barriers (p = .02), cancer worry severity (p = .01), and self-efficacy (p = .002) were significant predictors of willingness to adopt biomarker profiling, and susceptibility was marginally related (p = .09). The direct effects are qualified by two interactions between psychosocial predictors of the health belief model and participants' age. The model predicted willingness to adopt biomarker screening well (R 2 = 28%), and may be used successfully as a framework to assess the diffusion of biomarker screening acceptability.
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Affiliation(s)
- Nick Carcioppolo
- Department of Communication Studies and Affiliate Faculty at the Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Katheryn R Christy
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jakob D Jensen
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Andy J King
- Department of Public Relations, Texas Tech University, Lubbock, TX, USA
| | - Julie Goonewardene
- American Medical Association, Chicago, IL, USA.,Innovation and Entrepreneurship, University of Kansas, Lawrence, KS, USA
| | - Daniel Raftery
- Department of Anesthesiology and Pain Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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13
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Ratcliff CL, Kaphingst KA, Jensen JD. When Personal Feels Invasive: Foreseeing Challenges in Precision Medicine Communication. JOURNAL OF HEALTH COMMUNICATION 2017; 23:144-152. [PMID: 29279048 DOI: 10.1080/10810730.2017.1417514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Precision medicine (PM) draws upon individual biological and psychosocial factors to create a personalized approach to healthcare. To date, little is known about how healthcare consumers will respond to such highly personalized guidance and treatment. The assumption is that responses will generally be favorable; yet in the media and in online public discussions about PM, concerns have been raised about invasions of privacy and autonomy. Findings from the tailoring literature-relevant because PM is, in a sense, "hypertailoring"-similarly suggest a potential for provoking unintended consequences such as personalization reactance, wherein perceived threat to one's privacy or freedom can lead to rejection of the personalized message or its source. Here, we review extant tailoring and other relevant research to identify challenges that could arise in PM communication. We then draw upon a patient-centered communication perspective to highlight elements of the communication process wherein resistance could be mitigated. This review aims to provide preliminary guidance for practitioners when communicating with patients and healthcare consumers about PM, as well as point scholars toward fruitful topics for research in this emerging health communication area.
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Affiliation(s)
- Chelsea L Ratcliff
- a Department of Communication , University of Utah , Salt Lake City , Utah , USA
| | - Kimberly A Kaphingst
- a Department of Communication , University of Utah , Salt Lake City , Utah , USA
- b Huntsman Cancer Institute , Cancer Control and Population Sciences Program , Salt Lake City , Utah , USA
| | - Jakob D Jensen
- a Department of Communication , University of Utah , Salt Lake City , Utah , USA
- b Huntsman Cancer Institute , Cancer Control and Population Sciences Program , Salt Lake City , Utah , USA
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14
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Rodríguez VM, Robers E, Zielaskowski K, Javier González C, Hunley K, Kaphingst KA, Guest DD, Sussman A, Meyer White KA, Schwartz MR, Greb J, Talamantes Y, Bigney J, Berwick M, Hay JL. Translation and adaptation of skin cancer genomic risk education materials for implementation in primary care. J Community Genet 2016; 8:53-63. [PMID: 27924449 DOI: 10.1007/s12687-016-0287-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/17/2016] [Indexed: 12/15/2022] Open
Abstract
Genomic medicine has revolutionized disease risk identification and subsequent risk reduction interventions. Skin cancer risk genomic feedback is a promising vehicle to raise awareness and protective behaviors in the general population, including Hispanics who are largely unaware of their risks. Yet, personalized genomics currently has limited reach. This study is the initial phase of a randomized controlled trial investigating the personal utility and reach of genomic testing and feedback for melanoma. Semi-structured cognitive interviews (N = 28), stratified across education level, were conducted to assess the comprehension and acceptability of translated skin cancer genomic risk education materials with Spanish-speaking Hispanic primary care patients. Overall, materials were comprehensible and acceptable with 33 of 246 terms/concepts identified as difficult. Common problems included translation challenges (e.g., peeling from sunburn), ambiguous concepts (e.g., healthcare system), and problematic terms (e.g., risk version). Aiming to expand the reach of genomic medicine across subpopulations that may benefit from it, necessary modifications were made to education materials to improve comprehensibility, acceptability, and cultural relevance.
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Affiliation(s)
- Vivian M Rodríguez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA.
| | | | - Kate Zielaskowski
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA
| | - C Javier González
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA
| | | | | | | | | | | | | | - Jennie Greb
- University of New Mexico, Albuquerque, NM, USA
| | | | | | | | - Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA
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