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Paneque M, O Shea R, Narravula A, Siglen E, Ciuca A, Abulí A, Serra-Juhé C. Correction to: Thirty-years of genetic counselling education in Europe: a growing professional area. Eur J Hum Genet 2024:10.1038/s41431-024-01571-5. [PMID: 38462655 DOI: 10.1038/s41431-024-01571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Affiliation(s)
- M Paneque
- CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - R O Shea
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
- Cancer Genetic Service, St. James Hospital, Dublin, Ireland
| | | | - E Siglen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - A Ciuca
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - A Abulí
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - C Serra-Juhé
- Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
- U705 CIBERER, Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), 28029, Madrid, Spain
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Paneque M, O Shea R, Narravula A, Siglen E, Ciuca A, Abulí A, Serra-Juhé C. Thirty-years of genetic counselling education in Europe: a growing professional area. Eur J Hum Genet 2024:10.1038/s41431-024-01552-8. [PMID: 38355960 DOI: 10.1038/s41431-024-01552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Genetic counselling education and training in Europe spans a continuum of 30 years. More master programs are opening due the demand for qualified genetic counselors. This report describes the evolution of training in Europe and the current state of genetic counselling training programs. Directors of master programs in Europe were invited to complete an online survey describing their program, including year of commencement, course duration, number of students and frequency of intake and number graduating. Results of the survey were presented at a closed meeting at the European Society of Human Genetics conference in 2022 along with a facilitated stakeholder engagement session in which 19 professionals participated to understand the challenges in delivering genetic counselling education in Europe. A total of 10 active programs exists in Europe with the first training program starting in 1992. The majority of training programs have a 2-year duration, with just over half of programs having an annual intake of students. Up to May 2022, 710 students have graduated from genetic counseling training programs across Europe. Of these, 670 students graduated from European Board of Medical Genetics-registered programs. Arranging clinical placements, clinical and counseling supervision of students, research collaboration for MSc research projects and incorporating genomics into the curriculum were identified as current challenges for genetic counseling education. Genetic counseling is still a developing profession in Europe and this historical and current view of the European genetic counselor pathways, allows for educational and professional standards to be examined as the profession evolves into the future.
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Affiliation(s)
- M Paneque
- CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - R O Shea
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
- Cancer Genetic Service, St. James Hospital, Dublin, Ireland
| | | | - E Siglen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - A Ciuca
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - A Abulí
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - C Serra-Juhé
- Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
- U705 CIBERER, Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), 28029, Madrid, Spain
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Siglen E, Vetti HH, Augestad M, Steen VM, Lunde Å, Bjorvatn C. Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study. J Med Internet Res 2023; 25:e46571. [PMID: 37656502 PMCID: PMC10504626 DOI: 10.2196/46571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. OBJECTIVE Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. METHODS Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. RESULTS The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: "Anytime, anywhere"; "In addition, not instead"; and "Trustworthy and true." All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. CONCLUSIONS Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling.
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Affiliation(s)
- Elen Siglen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Hildegunn Høberg Vetti
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Mirjam Augestad
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Vidar M Steen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Åshild Lunde
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Cathrine Bjorvatn
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
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Siglen E, Vetti HH, Lunde ABF, Hatlebrekke TA, Strømsvik N, Hamang A, Hovland ST, Rettberg JW, Steen VM, Bjorvatn C. Ask Rosa - The making of a digital genetic conversation tool, a chatbot, about hereditary breast and ovarian cancer. Patient Educ Couns 2022; 105:1488-1494. [PMID: 34649750 DOI: 10.1016/j.pec.2021.09.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We aimed at developing a pilot version of an app (Rosa) that can perform digital conversations with breast or ovarian cancer patients about genetic BRCA testing, using chatbot technology, to identify best practices for future patient-focused chatbots. METHODS We chose a commercial chatbot platform and participatory methodology with a team of patient representatives, IT engineers, genetic counselors and clinical geneticists, within a nationwide collaboration. An iterative approach ensured extensive user and formal usability testing during the development process. RESULTS The development phase lasted for two years until the pilot version was completed in December 2019. The iteration steps disclosed major challenges in the artificial intelligence (AI)-based matching of user provided questions with predefined information in the database, leading initially to high level of fallback answers. We therefore developed strategies to reduce potential language ambiguities (e.g. BRCA1 vs BRCA2) and overcome dialogue confusion. The first prototype contained a database with 500 predefined questions and 67 corresponding predefined answers, while the final version included 2257 predefined questions and 144 predefined answers. Despite the limited AI functionality of the chatbot, the testing revealed that the users liked the layout and found the chatbot trustworthy and reader friendly. CONCLUSIONS Building a health chatbot is challenging, expensive and time consuming with today's technology. The users had a positive attitude to the chatbot, and would use it in a real life setting, if given to them by health care personnel. PRACTICE IMPLICATIONS We here present a framework for future health chatbot initiatives. The participatory methodology in combination with an iterative approach ensured that the patient perspective was incorporated at every level of the development process. We strongly recommend this approach in patient-centered health innovations.
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Affiliation(s)
- Elen Siglen
- Western Norway Familial Cancer Center, Haukeland University Hospital, Bergen, Norway.
| | - Hildegunn Høberg Vetti
- Western Norway Familial Cancer Center, Haukeland University Hospital, Bergen, Norway; Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | | | | | - Nina Strømsvik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Northern Norway Familial Cancer Center, University Hospital of North-Norway, Tromsø, Norway
| | - Anniken Hamang
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | | | - Vidar M Steen
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Cathrine Bjorvatn
- Western Norway Familial Cancer Center, Haukeland University Hospital, Bergen, Norway; Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
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Nazareth S, Nussbaum RL, Siglen E, Wicklund CA. Chatbots & artificial intelligence to scale genetic information delivery. J Genet Couns 2020; 30:7-10. [PMID: 33191601 DOI: 10.1002/jgc4.1359] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Elen Siglen
- Western Norway Familial Cancer Center, Haukeland University Hospital, Bergen, Norway
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Høberg-Vetti H, Eide GE, Siglen E, Listøl W, Haavind MT, Hoogerbrugge N, Bjorvatn C. Cancer-related distress in unselected women with newly diagnosed breast or ovarian cancer undergoing BRCA1/2 testing without pretest genetic counseling. Acta Oncol 2019; 58:175-181. [PMID: 30334464 DOI: 10.1080/0284186x.2018.1502466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Genetic testing is increasing in patients newly diagnosed with cancer. This study investigated the levels, course and predictors of cancer-related distress, defined as intrusion and avoidance, in women undergoing BRCA1/2 testing without pretest genetic counseling shortly after a diagnosis of breast or ovarian cancer. MATERIAL AND METHODS Unselected for family history or age, 259 women with breast cancer and 50 women with ovarian cancer, underwent BRCA1/2 testing shortly after diagnosis. Cancer-related distress was measured with the Impact of Event Scale before and after genetic testing. In order to identify predictors of distress, the subscale scores were regressed on baseline predictor variables including sociodemographic and medical variables, perceived social support, and decisional conflict regarding genetic testing. RESULTS The mean levels of intrusion and avoidance were in the moderate range both before and after genetic testing with a statistically significant decline during follow-up. Younger age, shorter time since diagnosis, lower levels of social support, and a diagnosis of ovarian cancer predicted higher levels of both intrusion and avoidance. In addition, higher levels of decisional conflict and living with a partner predicted higher levels of intrusion. CONCLUSIONS Women having genetic testing shortly after a diagnosis of breast or ovarian cancer had a moderate mean level of cancer-related distress, which decreased with time. Health personnel offering genetic testing to newly diagnosed women with breast or ovarian cancer should be aware of the potential predictors for increased cancer-related distress identified in this study: younger age, less perceived social support, higher levels of decisional conflict regarding genetic testing, and living with a partner.
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Affiliation(s)
- Hildegunn Høberg-Vetti
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elen Siglen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Wenche Listøl
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Marianne Tveit Haavind
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Nicoline Hoogerbrugge
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cathrine Bjorvatn
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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Siglen E, Bjorvatn C, Engebretsen LF, Berglund G, Natvig GK. The influence of cancer-related distress and sense of coherence on anxiety and depression in patients with hereditary cancer: a study of patients' sense of coherence 6 months after genetic counseling. J Genet Couns 2007; 16:607-15. [PMID: 17694398 DOI: 10.1007/s10897-007-9095-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 02/08/2007] [Indexed: 10/22/2022]
Abstract
This study examines the association between Sense of Coherence and anxiety and depression amongst patients at risk of hereditary cancer receiving genetic counseling. When writing this article, 144 patients referred for genetic counseling due to a suspicion of hereditary cancer in the family were recruited for this multicentered longitudinal study on the psychosocial aspects of genetic counseling in Norway. A total of 96 (66%) patients responded to the follow-up survey distributed 6 months after genetic counseling. This survey included the Sense of Coherence-29 Scale, Impact of Event Scale, and Hospital Anxiety and Depression Scale. Multiple regression analyses were applied. Our results show association between cancer-related distress and symptoms of anxiety and depression. Sense of Coherence is significantly associated with both anxiety and depression. The hypothesis of Sense of Coherence buffering cancer-related distress and the possible impact of these findings for genetic counseling are discussed.
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Affiliation(s)
- Elen Siglen
- Section of Nursing Science, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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