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Gilmore MJ, Leo MC, Amendola LM, Goddard KAB, Hunter JE, Joseph G, Kauffman TL, Rolf B, Shuster E, Zepp JM, Wilfond BS, Biesecker BB. Evaluation of mailed results versus telephone disclosure of normal cancer genetic test results in a low-risk underserved population. Transl Behav Med 2024:ibad084. [PMID: 38190737 DOI: 10.1093/tbm/ibad084] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Scalable models for result disclosure are needed to ensure large-scale access to genomics services. Research evaluating alternatives to genetic counseling suggests effectiveness; however, it is unknown whether these findings are generalizable across populations. We assessed whether a letter is non-inferior to telephone genetic counseling to inform participants with no personal or family history of cancer of their normal results. Data were collected via self-report surveys before and after result disclosure (at 1 and 6 months) in a study sample enriched for individuals from underserved populations. Primary outcomes were subjective understanding of results (global and aggregated) and test-related feelings, ascertained via three subscales (uncertainty, negative emotions, and positive feelings) of the Feelings About genomiC Testing Results (FACToR) measure. Secondary outcomes related to satisfaction with communication. Non-inferiority tests compared outcomes among disclosure methods. Communication by letter was inferior in terms of global subjective understanding of results (at 1 month) and non-inferior to telephoned results (at 6 months). Letter was non-inferior to telephone for aggregated understanding (at 6 months). Letter was superior (at 1 month) to telephone on the uncertainty FACToR subscale. Letter was non-inferior to telephone on the positive-feelings FACToR subscale (at 6 months). Letter was non-inferior to telephone for satisfaction with mode of result delivery and genetic test results. Communication via letter was inferior to telephone in communicating the "right amount of information." The use of written communication to relay normal results to low-risk individuals is a promising strategy that may improve the efficiency of care delivery.
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Affiliation(s)
- Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, NC, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Bradley Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Gilmore MJ, Knerr S, Kraft SA, Bulkley JE, Biesecker BB, Feigelson HS, Hunter JE, Jenkins CL, Kauffman TL, Lee SSJ, Liles EG, Mittendorf KF, Muessig KR, Porter KM, Rolf BA, Rope AF, Zepp JM, Anderson KP, Devine B, Joseph G, Leo MC, Goddard K, Wilfond BS. Improving Care for Marginalized Populations at Risk for Hereditary Cancer Syndromes: Innovations that Expanded Reach in the CHARM Study. Public Health Genomics 2023; 27:16-22. [PMID: 38142673 DOI: 10.1159/000535610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA,
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | | | - Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | | | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bradley A Rolf
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, Washington, USA
| | - Alan F Rope
- Genome Medical, South San Francisco, California, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | - Beth Devine
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Katrina Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
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Lewis H, Biesecker B, Lee SSJ, Anderson K, Joseph G, Jenkins CL, Bulkley JE, Leo MC, Goddard KAB, Wilfond BS. Promoting equity, inclusion, and efficiency: A team science approach to the development of authorship guidelines for a multi-disciplinary research team. J Clin Transl Sci 2023; 7:e265. [PMID: 38229898 PMCID: PMC10790100 DOI: 10.1017/cts.2023.685] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/18/2024] Open
Abstract
Large research teams and consortia present challenges for authorship. The number of disciplines involved in the research can further complicate approaches to manuscript development and leadership. The CHARM team, representing a multi-disciplinary, multi-institutional genomics implementation study, participated in facilitated discussions inspired by team science methodologies. The discussions were centered on team members' past experiences with authorship and perspectives on authorship in a large research team context. Team members identified challenges and opportunities that were used to create guidelines and administrative tools to support manuscript development. The guidelines were organized by the three values of equity, inclusion, and efficiency and included eight principles. A visual dashboard was created to allow all team members to see who was leading or involved in each paper. Additional tools to promote equity, inclusion, and efficiency included providing standardized project management for each manuscript and making "concept sheets" for each manuscript accessible to all team members. The process used in CHARM can be used by other large research teams and consortia to equitably distribute lead authorship opportunities, foster coauthor inclusion, and efficiently work with large authorship groups.
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Affiliation(s)
- Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle
Children’s Research Institute, Seattle, WA,
USA
| | | | - Sandra Soo-Jin Lee
- Department of Medical Humanities and Ethics, Columbia
University, New York, NY, USA
| | | | - Galen Joseph
- Department of Humanities and Social Sciences, University of
California, San Francisco, CA,
USA
| | - Charisma L. Jenkins
- Department of Translational and Applied Genomics, Kaiser
Permanente Center for Health Research, Portland,
OR, USA
| | - Joanna E. Bulkley
- Department of Translational and Applied Genomics, Kaiser
Permanente Center for Health Research, Portland,
OR, USA
| | - Michael C. Leo
- Department of Translational and Applied Genomics, Kaiser
Permanente Center for Health Research, Portland,
OR, USA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Kaiser
Permanente Center for Health Research, Portland,
OR, USA
- Division of Cancer Control and Population Sciences, National
Cancer Institute, National Institutes of Health, Rockville,
MD, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle
Children’s Research Institute, Seattle, WA,
USA
- Department of Pediatrics, Division of Bioethics and Palliative Care,
University of Washington, Seattle,
WA, USA
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4
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Hunter JE, Riddle L, Joseph G, Amendola LM, Gilmore MJ, Zepp JM, Shuster E, Bulkley JE, Muessig KR, Anderson KP, Goddard KAB, Wilfond BS, Leo MC. Most people share genetic test results with relatives even if the findings are normal: Family communication in a diverse population. Genet Med 2023; 25:100923. [PMID: 37421176 PMCID: PMC10766857 DOI: 10.1016/j.gim.2023.100923] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
PURPOSE With increasing utilization of genetic testing, sharing genetic information can become part of general family health communication while providing biological relatives with important information about their own genetic risk. Importantly, little is known about motivations for and barriers to family communication of genetic information in historically underserved populations. METHODS Using mixed methods, we explored patient experiences with family communication in a study population of English- and Spanish-speaking adults aged 18 to 49 years, enriched for participants from historically underserved backgrounds. Risk screening for hereditary cancer guided genetic testing for cancer risk genes and other medically actionable findings. RESULTS Most participants overall (91%), including most with normal findings (89%), shared or planned to share their results with relatives. Common motivations for sharing results were to give relatives information about their genetic risk and because the participant thought the results were interesting. Reasons for not sharing were limited contact with relatives, perceptions of limited clinical utility for relatives, and concern that discussion of genetic information was stigmatized or taboo. CONCLUSION Results demonstrate high rates of sharing genetic information, indicate motivations for sharing go beyond facilitating genetic testing for relatives, and suggest general willingness to share genetic information as part of family health communication.
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Affiliation(s)
- Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, NC; Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR.
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Katherine P Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
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Lowe C, Erby L, Joseph G, Biesecker B, Roter DL. Acceptability of an online communication training intervention for genetic counseling students. J Genet Couns 2023. [PMID: 37795757 DOI: 10.1002/jgc4.1790] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023]
Abstract
Technology provides opportunities to enhance communication skills training for genetic counseling graduate students. We assessed the acceptability of an online communication training program. Graduate student volunteers completed five online training modules on basic communication skills with opportunities to practice the skills within three simulated/standardized patient (SP) sessions. Participants completed online questionnaires reporting on acceptability, perceived usefulness, and realism of the modules and SP sessions. They also reported on the ease of transferring skills from the modules to clinical practice. Out of the 60 students who completed the baseline session, 35 (58%) completed all five training modules. Out of these 35 students, most found the modules to be useful (94%) and agreed that they were relevant to clinical practice (97%). At least 88% of participants found the genetic counselors, patient, and case scenarios to be realistic. Twenty-eight students had participated in clinical rotations since completing the intervention. Of these, 17 (61%) reported that it was at least slightly easy to use the skills in actual clinical cases. Most students also reported being able to transfer the skills they had learned into clinical practice. While the training was well-received, the relatively low completion rate of 58% raises concern that the intervention may need formal integration into the program curriculum to succeed due to the time and effort demands on students.
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Affiliation(s)
- Chenery Lowe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lori Erby
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Barbara Biesecker
- RTI International, Analytics, Research Triangle Park, North Carolina, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
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Riddle L, Joseph G, Caruncho M, Koenig BA, James JE. The role of polygenic risk scores in breast cancer risk perception and decision-making. J Community Genet 2023; 14:489-501. [PMID: 37311883 PMCID: PMC10576692 DOI: 10.1007/s12687-023-00655-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Abstract
Polygenic risk scores (PRS) have the potential to improve the accuracy of clinical risk assessments, yet questions about their clinical validity and readiness for clinical implementation persist. Understanding how individuals integrate and act on the information provided by PRS is critical for their effective integration into routine clinical care, yet few studies have examined how individuals respond to the receipt of polygenic risk information. We conducted an embedded Ethical, Legal, and Social Implications (ELSI) study to examine if and how unaffected participants in a US population breast cancer screening trial understood and utilized PRS, as part of a multifactorial risk score combining traditional risk factors with a genetic risk assessment, to make screening and risk-reduction decisions. Semi-structured qualitative interviews were conducted with 24 trial participants who were designated at elevated risk for breast cancer due to their combined risk score. Interviews were analyzed using a grounded theory approach. Participants understood PRS conceptually and accepted it as one of many risk factors to consider, yet the value and meaning they ascribed to this risk estimate varied. Most participants reported financial and insurance barriers to enhanced screening with MRI and were not interested in taking risk-reducing medications. These findings contribute to our understanding of how PRS may be best translated from research to clinical care. Furthermore, they illuminate ethical concerns about identifying risk and making recommendations based on polygenic risk in a population screening context where many may have trouble accessing appropriate care.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Ann Koenig
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Elyse James
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA.
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Beck AL, Mora R, Joseph G, Perrin E, Cabana M, Schickedanz A, Fernandez A. A Multimethod Evaluation of the Futuros Fuertes Intervention to Promote Healthy Feeding, Screen Time, and Sleep Practices. Acad Pediatr 2023; 23:1351-1360. [PMID: 37211275 DOI: 10.1016/j.acap.2023.05.006] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors. CONCLUSIONS Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants.
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Affiliation(s)
- Amy L Beck
- Department of Pediatrics, School of Medicine (AL Beck), University of California San Francisco.
| | - Rosa Mora
- School of Medicine (R Mora), University of California San Francisco
| | - Galen Joseph
- Department of Humanities and Social Medicine, School of Medicine (G Joseph), University of California San Francisco
| | - Eliana Perrin
- Department of Pediatrics, Schools of Medicine and Nursing (E Perrin), Johns Hopkins University, Baltimore, Md
| | - Michael Cabana
- Department of Pediatrics (M Cabana), Albert Einstein College of Medicine, New York, NY
| | - Adam Schickedanz
- Department of Pediatrics (A Schickedanz), University of California Los Angeles
| | - Alicia Fernandez
- Department of Medicine (A Fernandez), University of California San Francisco
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Duenas DM, Riddle L, Guerra C, Caruncho M, Lewis H, Porter KM, Kraft SA, Anderson KP, Biesecker B, Gilmore MJ, Zepp JM, Leo MC, Wilfond BS, Joseph G. Refining a Multifaceted Model of Perceived Utility of Genomic Sequencing Results. Public Health Genomics 2023; 26:135-144. [PMID: 37607497 PMCID: PMC10614499 DOI: 10.1159/000531782] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Research on the perceived utility of genomic sequencing has focused primarily on pediatric populations and on individuals and families with rare genetic diseases. Here, we evaluate how well a multifaceted perceived utility model developed with these populations applies to a diverse, adult population aged 18-49 at risk for hereditary cancer and propose new considerations for the model. METHODS Participants received clinical genomic sequencing in the Cancer Health Assessments Reaching Many (CHARM) study. Semi-structured qualitative interviews were conducted with a subset of participants at 1 and 6 months after results disclosure. We used an approach influenced by grounded theory to examine perceptions of the utility of genomic sequencing and analyzed how utility in CHARM mapped to the published multifaceted perceived utility model, noting which domains were represented or absent and which were most salient to our population. RESULTS Participants' discussions of utility often involved multiple domains and revealed the variety of ways in which receiving sequencing results can impact one's life. Results demonstrated that an individual's perception of utility can change over the life course when sequenced at a relatively young age and may be influenced by the resources available to them to act on the results. CONCLUSION Our findings demonstrate the relevance of a multifaceted perceived utility model for a diverse adult population at risk for hereditary cancer. We identified refinements that could make the model more robust, including emphasizing the overlapping nature of the domains and the importance of life stage and personal resources to the perception of utility.
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Affiliation(s)
- Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Claudia Guerra
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Mikaella Caruncho
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hannah Lewis
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine P. Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
| | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - On behalf of the CHARM Study
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
- Analytics, RTI International, Washington, DC, USA
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Joseph G, Lindberg NM, Guerra C, Hernandez C, Karliner LS, Gilmore MJ, Zepp J, Rolf BA, Caruncho M, Riddle L, Kauffman TL, Leo MC, Wilfond BS. Medical interpreter-mediated genetic counseling for Spanish preferring adults at risk for a hereditary cancer syndrome. J Genet Couns 2023; 32:870-886. [PMID: 36938783 PMCID: PMC10509308 DOI: 10.1002/jgc4.1695] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023]
Abstract
The objective of this study was to identify interpretation challenges specific to exome sequencing and errors of potential clinical significance in the context of genetic counseling for adults at risk for a hereditary cancer syndrome. Thirty transcripts of interpreter-mediated telephone results disclosure genetic counseling appointments were coded for errors by bilingual researchers, and the coders applied an overall rating to denote the degree to which the errors interfered with communication overall. Genetic counselors reviewed a subset of errors flagged for potential clinical significance to identify those likely to have clinical impact. Qualitative interviews with 19 interpreters were analyzed to elucidate the challenges they face in interpreting for genetic counseling appointments. Our analysis identified common interpretation errors such as raising the register, omissions, and additions. Further, we found errors specific to genetic counseling concepts and content that appeared to impact the ability of the genetic counselor to accurately assess risk. These errors also may have impacted the patient's ability to understand their results, access appropriate follow-up care, and communicate with family members. Among interpreters' strengths was the use of requests for clarification; in fact, even more use of clarification would have been beneficial in these encounters. Qualitative interviews surfaced challenges stemming from the structure of interpreter work, such as switching from medical and nonmedical interpretations without substantial breaks. Importantly, while errors were frequent, most did not impede communication overall, and most were not likely to impact clinical care. Nevertheless, potentially clinically impactful errors in communication of genetics concepts may contribute to inequitable care for limited English proficient patients and suggest that additional training in genetics and specialization in healthcare may be warranted. In addition, training for genetic counselors and guidance for patients in working effectively with interpreters could enhance interpreters' transmission of complex genetic concepts.
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Affiliation(s)
- Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Claudia Guerra
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Cindy Hernandez
- Cancer Genetics and Prevention Program, University of California, San Francisco, San Francisco, California, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Leah S Karliner
- Department of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jamilyn Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mikaella Caruncho
- Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
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Lowe C, Erby L, Biesecker B, Beach MC, Joseph G, Hundert R, Roter DL. Efficacy of an online communication skill training intervention on genetic counseling students' performance during standardized patient sessions. Patient Educ Couns 2023; 114:107835. [PMID: 37301010 DOI: 10.1016/j.pec.2023.107835] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the efficacy of a brief, online intervention designed to enhance genetic counseling students' patient-centered communication. METHODS Genetic counseling students and recent graduates were randomized to two groups following a baseline standardized patient (SP) session: (1) immediate intervention exposure, which consisted of five modules that taught patient-centered communication skills followed by a second SP session, or (2) delayed intervention exposure following completion of the second session. Sessions were coded using the Roter Interaction Analysis System. Short-term efficacy was assessed by comparing communication during the second session between the delayed and immediate intervention exposure groups. Longer-term efficacy was assessed by comparing communication during a third session approximately five weeks later. RESULTS During the second session, students in the immediate intervention exposure group (n = 18) used more emotionally responsive statements and were more likely to use teach-back than those in the delayed intervention exposure group (n = 23). Students' emotionally responsive statements decreased among the immediate intervention exposure group during the third session. CONCLUSION Exposure to the intervention was associated with multiple, positive changes to students' patient-centered communication behavior. PRACTICE IMPLICATIONS These time- and resource-efficient modules may be beneficial as an introduction to communication skills training or a supplement to existing training.
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Affiliation(s)
- Chenery Lowe
- Johns Hopkins University, Department of Health, Behavior and Society, Baltimore, USA.
| | - Lori Erby
- National Human Genome Research Institute, Center for Precision Health Research, Bethesda, USA
| | - Barbara Biesecker
- RTI International, Genomics, Ethics, and Translational Research Program, Research Triangle Park, USA
| | | | - Galen Joseph
- University of California San Francisco, Department of Humanities and Social Sciences, San Francisco, USA
| | - Rachel Hundert
- Johns Hopkins University, Department of Health, Behavior and Society, Baltimore, USA
| | - Debra L Roter
- Johns Hopkins University, Department of Health, Behavior and Society, Baltimore, USA
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James JE, Riddle L, Caruncho M, Koenig BA, Joseph G. A qualitative study of unaffected ATM and CHEK2 carriers: How participants make meaning of 'moderate risk' genetic results in a population breast cancer screening trial. J Genet Couns 2022; 31:1421-1433. [PMID: 35877161 PMCID: PMC9722572 DOI: 10.1002/jgc4.1617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
Relatively little is known about experiences of individuals with a pathogenic variant in a moderately penetrant breast cancer gene, particularly those without a personal history of cancer. The WISDOM trial is testing a model of risk-based breast cancer screening that integrates genomic (nine genes and polygenic risk) and other risk factors. In the context of an embedded Ethical, Legal, and Social Implications (ELSI) study of WISDOM, we conducted qualitative interviews at two timepoints post-result disclosure with 22 ATM and CHEK2 carriers. Results disclosure and interview recordings were transcribed and analyzed using a grounded theory analysis framework. We found that participants minimized the significance of their results in comparison to BRCA; were surprised but not alarmed by the results in the absence of family history; did not fundamentally change their perception of their breast cancer risk despite the new genomic information; exhibited variable responses to WISDOM's screening and risk reduction recommendations; and shared test results with family but did not strongly encourage cascade testing. Participants viewed the results as having limited utility and responded accordingly. Our study offers important insights into how genetic test results for moderate-risk genes are received, understood, and acted upon in population screening context.
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Affiliation(s)
- Jennifer Elyse James
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Barbara Ann Koenig
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
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Solomou G, Gharooni A, Whitehouse K, Poon MTC, Piper RJ, Fountain DM, Khan DZ, Lopez CC, Ooi SZ, Lammy S, Maqsood R, Brochert RJ, Patel W, Baig A, Haq M, O’Donnell A, Joseph G, Kolias AG, Ashkan K, Jenkinson MD, Plaha P, Price SJ, Watts C. OS07.2.A Evaluation of Intraoperative Surgical Adjuncts and Resection of Glioblastoma (ELISAR GB): A UK and Ireland multicentre, prospective observational cohort study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.047] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite operative and adjuvant therapies, glioblastoma remains incurable, with the extent of resection being one of few treatments that can improve survival. To improve resection, operative adjuncts are used, with neuronavigation and 5-aminolevulinic acid (5-ALA) recommended as a standard of care in those aimed for maximal safe resection. Despite the standards, meta-analysis concluded that the impact of 5-ALA on the extent of surgical resection is of low quality due to bias in reporting tumour location and additional image guidance used, factors impacting on extent of resection as well as short-term neurological outcomes being uncertain. Therefore we aimed to evaluate the availability and use of 5-ALA and other adjuncts and compare surgical outcomes of 5-ALA-guided versus non-5-ALA-guided resections.
Material and Methods
A multicenter prospective observational cohort study was conducted across 27 out of 31 available centres in the UK and Ireland from 6 January until 19 March 2020. Inclusion criteria included adults with first diagnosis, supratentorial glioblastoma undergoing resection. Primary outcomes included: i) the availability and use of surgical adjuncts and ii) complete resection of enhancing tissue (CRET). Secondary outcomes included adverse events, new onset of postoperative neurological deficit and post-operative neurological function. Descriptive and inferential statistics were used for analysis with a p-value <0.05 deemed significant.
Results
232 consecutive cases were identified. 142/232 cases were aimed for maximal safe resection subsequently divided into 5-ALA-guided (n=92) versus non-5-ALA-guided (n=50) resections. 5-ALA and neuronavigation were available across all centres. Neuronavigation and 5-ALA were used in 91% (n=129/142) and 65% (n=92/142) of cases aimed for maximal safe resection whereas 83% (n=75/90) and 49% (n=44/90) for debulk surgery. 35 unique combinations of surgical adjuncts were used in 232 operations. 5-ALA-guided resection yielded a higher percentage of CRET than without (55% versus 28%, p < 0.01). The two groups showed no difference in adverse events (p=0.98), new onset of neurological deficit (p=0.88) nor neurological function (p=0.7). A logistic regression analysis showed that 5-ALA was an important predictor of CRET regardless of additional adjuncts used (OR 2.4, CI 0.96-5.97, P = 0.05), tumour location and molecular characterisation (OR 3.48, CI 1.61-7.51, P <0.01).
Conclusion
Firstly, we showed that 5-ALA is not always used for glioblastoma aimed for CRET. Secondly, we report a great heterogeneity of adjuncts used for resection, possibly explained by a lack of high-quality evidence and surgeon training. Thirdly we demonstrate that 5-ALA-guided resection leads to higher percentage of CRET regardless of other adjuncts used, tumour location and molecular characterisation.
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Affiliation(s)
- G Solomou
- University of Cambridge , Cambridge , United Kingdom
| | - A Gharooni
- University of Cambridge , Cambridge , United Kingdom
| | - K Whitehouse
- Department of Neurosurgery, University Hospital of Wales, , Cardiff , United Kingdom
| | - M T C Poon
- Usher Institute, The University of Edinburgh , Edinburgh , United Kingdom
| | - R J Piper
- Department of Neurosurgery, John Radcliffe Hospital , Oxford , United Kingdom
| | - D M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, , Manchester , United Kingdom
| | - D Z Khan
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, National Hospital for Neurology and Neurosurgery , London , United Kingdom
| | - C C Lopez
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, , Manchester , United Kingdom
| | - S Z Ooi
- Cardiff University School of Medicine, Cardiff , Cardiff , United Kingdom
| | - S Lammy
- Department of Neurosurgery Institute of Neurological Sciences , Glasgow , United Kingdom
| | - R Maqsood
- University of Glasgow , Glasgow , United Kingdom
| | - R J Brochert
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University , Cambridge , United Kingdom
| | - W Patel
- Department of Neurosurgery, John Radcliffe Hospital , Oxford , United Kingdom
| | - A Baig
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Haq
- GKT School of Medical Education, Guy’s Campus , London , United Kingdom
| | - A O’Donnell
- Royal Sussex County Hospital , Brighton , United Kingdom
| | - G Joseph
- Keele University, Institute of Science and Technology , Keele , United Kingdom
| | - A G Kolias
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University , Cambridge , United Kingdom
| | - K Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, King’s College London, , London , United Kingdom
| | - M D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, , Liverpool , United Kingdom
| | - P Plaha
- Department of Neurosurgery, John Radcliffe Hospital , Oxford , United Kingdom
| | - S J Price
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University , Cambridge , United Kingdom
| | - C Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham , Birmingham , United Kingdom
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James JE, Joseph G. "It's personalized, but it's still bucket based": The promise of personalized medicine vs. the reality of genomic risk stratification in a breast cancer screening trial. New Genet Soc 2022; 41:228-253. [PMID: 36936188 PMCID: PMC10021681 DOI: 10.1080/14636778.2022.2115348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Adaptive pragmatic clinical trials offer an innovative approach that integrates clinical care and research. Yet, blurring the boundaries between research and clinical care raises questions about how clinicians and investigators balance their caregiving and research roles and what types of knowledge and risk assessment are most valued. This paper presents findings from an ethnographic ELSI (Ethical, Legal, Social Implications) study of an innovative clinical trial of risk-based breast cancer screening that utilizes genomics to stratify risk and recommend a breast cancer screening commensurate with the assessed risk. We argue that the trial demonstrates a fundamental tension between the promissory ideals of personalized medicine, and the reality of implementing risk stratified care on a population scale. We examine the development of a Screening Assignment Review Board in response to this tension which allows clinician-investigators to negotiate, but never fully resolve, the inherent contradiction of 'precision population screening'.
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Affiliation(s)
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco
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14
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Mittendorf KF, Lewis HS, Duenas DM, Eubanks DJ, Gilmore MJ, Goddard KAB, Joseph G, Kauffman TL, Kraft SA, Lindberg NM, Reyes AA, Shuster E, Syngal S, Ukaegbu C, Zepp JM, Wilfond BS, Porter KM. Literacy-adapted, electronic family history assessment for genetics referral in primary care: patient user insights from qualitative interviews. Hered Cancer Clin Pract 2022; 20:22. [PMID: 35689290 PMCID: PMC9188215 DOI: 10.1186/s13053-022-00231-3] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment for hereditary cancer syndromes is recommended in primary care, but family history is rarely collected in enough detail to facilitate risk assessment and referral - a roadblock that disproportionately impacts individuals with healthcare access barriers. We sought to qualitatively assess a literacy-adapted, electronic patient-facing family history tool developed for use in diverse, underserved patient populations recruited in the Cancer Health Assessments Reaching Many (CHARM) Study. METHODS Interview participants were recruited from a subpopulation of CHARM participants who experienced barriers to tool use in terms of spending a longer time to complete the tool, having incomplete attempts, and/or providing inaccurate family history in comparison to a genetic counselor-collected standard. We conducted semi-structured interviews with participants about barriers and facilitators to tool use and overall tool acceptability; interviews were recorded and professionally transcribed. Transcripts were coded based on a codebook developed using inductive techniques, and coded excerpts were reviewed to identify overarching themes related to barriers and facilitators to family history self-assessment and acceptability of the study tool. RESULTS Interviewees endorsed the tool as easy to navigate and understand. However, they described barriers related to family history information, literacy and language, and certain tool functions. Participants offered concrete, easy-to-implement solutions to each barrier. Despite experience barriers to use of the tool, most participants indicated that electronic family history self-assessment was acceptable or preferable in comparison to clinician-collected family history. CONCLUSIONS Even for participants who experienced barriers to tool use, family history self-assessment was considered an acceptable alternative to clinician-collected family history. Barriers experienced could be overcome with minor adaptations to the current family history tool. TRIAL REGISTRATION This study is a sub-study of the Cancer Health Assessments Reaching Many (CHARM) trial, ClinicalTrials.gov, NCT03426878. Registered 8 February 2018.
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Affiliation(s)
- Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Hannah S Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Ana A Reyes
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Chinedu Ukaegbu
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.
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Goel R, Babu M, Padiyar S, Joseph G, Danda D. OP0187 COMPARATIVE EFFICACY OF NON-BIOLOGIC IMMUNOSUPPRESSANTS IN TAKAYASU ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe choice of immunosuppressant (IS) in patients with Takayasu arteritis (TAK) is often arbitrary due to lack of comparison studies.ObjectivesIn this retrospective, we aimed to compare the efficacy of 3 non biologic IS including azathioprine (AZA), mycophenolate mofetil (MMF) and methotrexate (MTX) in inducing and maintaining sustained remission in patients with TAK.MethodsPatients with a diagnosis of TAK, attending our clinics between Jan 2000 and May 2019 were identified. Those who satisfied either ACR or Sharma’s classification or EULAR PRINTO PRES criteria and/or had angiographic evidence of Takayasu arteritis with a minimum 2 follow up visits were included. Patients who received upfront biologics were excluded. The patients were matched for parameters statistically different among three groups using propensity score analysis. Clinical details at the index visit defined as the time of initiation of first IS and follow up visits were prospectively recorded and retrospectively noted from electronic medical records. The primary outcomes were attainment of complete remission and relapses. Disease activity was assessed by Indian Takayasu arteritis score (ITAS), C-reactive protein and angiograms. Relapse was defined as ITAS-A(CRP) >=2 and/or progression in angiograms and/or escalation of steroid dose and/or switching of IS due to active disease. The baseline variables of patients receiving AZA, MMF and MTX were compared using chi square test or Mann Whitney U test. The comparative efficacy of IS to induce complete remission was calculated using logistic regression and presented as odds ratio (95% CI). The cumulative risk of relapse was calculated using Cox-proportional hazards model with hazards ratio and 95% confidence interval (CI) after adjusting for duration of symptoms and juvenile onset disease. The patients were censored at the time of relapse or time of switching to another IS or last follow up whichever was the earliest. AZA was arbitrary chosen as the reference drug for all the analysis. The missing values (visits) were not included in analysis and the last observation was carried forwards. Data after switching of immunosuppressant of interest till the last follow up visit was analysed descriptively. All analysis were done for matched and unmatched patient groups. The results of matched and unmatched cohort were similar, hence the results of unmatched groups are presented here.ResultsOverall, 234 patients satisfying inclusion criteria including 53 (22.6%), 156 (66.7%) and 25 (10.7%) patients receiving AZA, MMF, Mtx respectively were studied. Complete remission (CR) was attained in 183 (78.2%) patients after initiating steroids and IS. 79.2%, 77.6% and 80% of patients receiving AZA, MMF or MTX respectively achieved CR yielding an odds ratio of 1.10 (0.52-2.37), p= 0.80 and 0.96 (0.29-3.12), p= 0.94 for MMF and MTX as compared with AZA. CR was sustained in 22 (52.4%), 80 (66.1%) and 11 (55%) of patients on AZA, MMF and MTX respectively. When compared with AZA, adjusted hazards ratio (AHR) of relapse was 1.51 (0.79-2.89), p=0.21 and 2.45 (1.00-5.99), p= 0.05 with MMF and MTX after adjusting for juvenile onset disease, type 1 and type 4 disease by angiography. The frequency of remission in patients who received MMF was significantly higher in patients who presented with type 4 disease (96%) as compared with the patients who had other types on angiography (74%), p= 0.017. Conversely, 63.6% of patients with type 1 disease responded to MMF which was significantly lower than 81.3% of patients with other angiographic types (p=0.037) while no such differential response was observed for AZA or MTX. Retrospective design and small number of patients in AZA and Mtx group were the major limitations of the study.ConclusionIn our patients with TAK, all the three IS were comparable in inducing remission. Azathioprine was equal to MMF but superior to MTX in maintaining relapse free sustained response. The efficacy of MMF differed across various angiographic types of disease.ReferencesNoneDisclosure of InterestsNone declared
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Amendola LM, Shuster E, Leo MC, Dorschner MO, Rolf BA, Shirts BH, Gilmore MJ, Okuyama S, Zepp JM, Kauffman TL, Mittendorf KF, Bellcross C, Jenkins CL, Joseph G, Riddle L, Syngal S, Ukaegbu C, Goddard KAB, Wilfond BS, Jarvik GP. Laboratory-related outcomes from integrating an accessible delivery model for hereditary cancer risk assessment and genetic testing in populations with barriers to access. Genet Med 2022; 24:1196-1205. [PMID: 35305866 DOI: 10.1016/j.gim.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This study aimed to evaluate the laboratory-related outcomes of participants who were offered genomic testing based on cancer family history risk assessment tools. METHODS Patients from clinics that serve populations with access barriers, who are screened at risk for a hereditary cancer syndrome based on adapted family history collection tools (the Breast Cancer Genetics Referral Screening Tool and PREMM5), were offered exome-based panel testing for cancer risk and medically actionable secondary findings. We used descriptive statistics, electronic health record review, and inferential statistics to explore participant characteristics and results, consultations and actions related to pathogenic/likely pathogenic variants identified, and variables predicting category of findings, respectively. RESULTS Of all the participants, 87% successfully returned a saliva kit. Overall, 5% had a pathogenic/likely pathogenic cancer risk variant and 1% had a secondary finding. Almost all (14/15, 93%) participants completed recommended consultations with nongenetics providers after an average of 17 months. The recommended actions (eg, breast magnetic resonance imaging) were completed by 17 of 25 participants. Participant personal history of cancer and PREMM5 score were each associated with the category of findings (history and colon cancer finding, Fisher's exact P = .02; history and breast cancer finding, Fisher's exact P = .01; PREMM5TM score; and colon cancer finding, Fisher's exact P < .001). CONCLUSION This accessible model of hereditary cancer risk assessment and genetic testing yielded results that were often acted upon by patients and physicians.
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Affiliation(s)
- Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael O Dorschner
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Department of Laboratory Medicine and Pathology, UW Medicine, University of Washington, Seattle, WA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Brian H Shirts
- Department of Laboratory Medicine and Pathology, UW Medicine, University of Washington, Seattle, WA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sonia Okuyama
- Division of Hematology-Oncology, Denver Health and Hospital Authority, Denver, CO
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Cecilia Bellcross
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Sapna Syngal
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA
| | - Chinedu Ukaegbu
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA; Division of Bioethics and Paliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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Dixit N, Velazquez Manana AI, Gordon K, Leung IC, Friedlander TW, Frick M, Trejo E, Levine K, DeBoer RJ, Lee R, Cheng JM, Couey P, Wang CCJ, Joseph G. Implementation of a “genetic testing station” in a safety net hospital to optimize access and increase equity. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18565] [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] [Indexed: 11/20/2022] Open
Abstract
e18565 Background: Diagnosis of hereditary cancers by genetic testing (GT) has significant implications for treatment decisions for individuals and risk reduction among family members. Recent guidelines have expanded the eligibility criteria for GT. However, significant disparities in GT completion persist based on race, ethnicity, insurance status, and English proficiency. Thus, novel interventions are needed to provide diverse populations equitable access to GT. Methods: From March to October 2021, we conducted a single arm study of a genetic testing station (GTS) intervention in a safety net hospital. The GTS intervention included (1) screening of clinic schedules for eligible patients; (2) video-based GT education in English, Spanish, and Cantonese; (3) consent for GT and collection of a blood or saliva sample by a genetic counseling assistant; (4) telehealth-based post-test counseling with a genetic counselor (GC). Bilingual, culturally concordant staff developed the educational videos and study materials. Patients who met the NCCN criteria for GT were eligible. We compared this group to a historical cohort who initiated GT in the preceding nine months. The historical cohort underwent GT in a traditional model: (1) oncologist-initiated referral, (2) pretest counseling with a GC, (3) GT if appropriate, and (4) post-test counseling to review and discuss results. Our primary outcomes were accessibility and feasibility assessed by tracking the implementation process. Secondary outcomes included completion rates of GT and post-test GC visit, and time from enrollment to GT result disclosure. We evaluated all associations with Chi-square tests for categorical variables and Pearson’s Chi-square test of medians for time to post-test visit. Results: We approached 92 patients for GTS; 3 declined, 89 patients underwent the GTS intervention. Of 155 patients (GTS: n = 89, historical cohort: n = 66), 15% were Black, 28% Asian, 17% White, 31% Hispanic/Latinx, 2% Native Hawaiian/Pacific Islander, and 7% multiethnic/other; 51% spoke English, 27% Spanish, 17% Cantonese, and 5% other. In the GTS cohort, 85 (96%) of participants completed GT and 80 (90%) completed the post-test GC visit, compared to 46 (70%, p < 0.001) and 42 (64%, p < 0.001) respectively in the historical cohort. The median time to result disclosure was 30.5 days (IQR 23.8 - 38.8) for the GTS cohort and 80.5 days (IQR 37.5 - 137.5, p = 0.001) for the historical cohort. Conclusions: Implementation of GTS was feasible and acceptable in a safety net setting. GTS resulted in more patients completing GT and post-test counseling and significantly reduced the time to result disclosure, which has the potential to impact treatment decisions and outcomes. As GT eligibility criteria broaden, innovative interventions, workflows, and tailored educational resources for diverse populations are needed to ensure equitable access to GT.
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Affiliation(s)
- Niharika Dixit
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | | | | | - Ivan C. Leung
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Terence W. Friedlander
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Miya Frick
- University of California-San Francisco, San Francisco, CA
| | - Evelin Trejo
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kendall Levine
- University of California-San Francisco, San Francisco, CA
| | | | - Robin Lee
- University of California-San Francisco, San Francisco, CA
| | - Judy M. Cheng
- University of California San Francisco, San Francisco, CA
| | - Paul Couey
- University of California-San Francisco, San Francisco, CA
| | | | - Galen Joseph
- University of California San Francisco, San Francisco, CA
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18
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Toudeka A, Jean Simon D, Joseph G, Akakpo-Ahianyo D. Grossesses adolescentes en milieu scolaire au Togo : déficit de communication entre parents-enfants ? Sexologies 2022. [DOI: 10.1016/j.sexol.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Ding L, Szymczak JE, Evans E, Canepa E, Martin AE, Contractor F, Aplenc R, Joseph G, Winestone LE. Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study. BMC Cancer 2022; 22:531. [PMID: 35550034 PMCID: PMC9095817 DOI: 10.1186/s12885-022-09547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis. METHODS This qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family's experiences preceding the patient's diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data. RESULTS Thirty-two interviews were conducted with a diverse population of English and Spanish speaking participants from two tertiary care pediatric cancer centers. Parents reported feeling frustrated when their intuition conflicted with providers' management decisions. Many felt laboratory testing was not performed soon enough. Additional contributors to delays included misattribution of vague symptoms to more common diagnoses, difficulties in obtaining appointments, and financial disincentives to seek urgent or emergent care. Reports of difficulty obtaining timely appointments and financial concerns were disproportionately raised among low-income Black and Hispanic participants. Comparatively, parents with prior healthcare experiences felt better able to navigate the system and advocate for additional testing at symptom onset. CONCLUSIONS While there are disease-related factors contributing to delays in diagnosis, it is important to recognize there are multiple non-disease-related factors that also contribute to delays. Evidence-based approaches to reduce outcome disparities in pediatric cancer likely need to start in the primary care setting where timeliness of diagnosis can be addressed.
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Affiliation(s)
- Lucky Ding
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Julia E. Szymczak
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Erica Evans
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Emma Canepa
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Ashley E. Martin
- grid.239552.a0000 0001 0680 8770Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Farah Contractor
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Richard Aplenc
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Galen Joseph
- grid.266102.10000 0001 2297 6811Department of Humanities and Social Sciences, UCSF, San Francisco, CA USA ,grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA
| | - Lena E. Winestone
- grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA ,Division of Allergy, Immunology & BMT, UCSF Benioff Children’s Hospitals, Mail Stop 0434, 550 16th St, 4th Floor, San Francisco, CA USA
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20
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O'Daniel JM, Ackerman S, Desrosiers LR, Rego S, Knight SJ, Mollison L, Byfield G, Anderson KP, Danila MI, Horowitz CR, Joseph G, Lamoure G, Lindberg NM, McMullen CK, Mittendorf KF, Ramos MA, Robinson M, Sillari C, Madden EB. Integration of stakeholder engagement from development to dissemination in genomic medicine research: Approaches and outcomes from the CSER Consortium. Genet Med 2022; 24:1108-1119. [PMID: 35227608 PMCID: PMC9081226 DOI: 10.1016/j.gim.2022.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There is a critical need for genomic medicine research that reflects and benefits socioeconomically and ancestrally diverse populations. However, disparities in research populations persist, highlighting that traditional study designs and materials may be insufficient or inaccessible to all groups. New approaches can be gained through collaborations with patient/community stakeholders. Although some benefits of stakeholder engagement are recognized, routine incorporation into the design and implementation of genomics research has yet to be realized. METHODS The National Institutes of Health-funded Clinical Sequencing Evidence-Generating Research (CSER) consortium required stakeholder engagement as a dedicated project component. Each CSER project planned and carried out stakeholder engagement activities with differing goals and expected outcomes. Examples were curated from each project to highlight engagement strategies and outcomes throughout the research lifecycle from development through dissemination. RESULTS Projects tailored strategies to individual study needs, logistical constraints, and other challenges. Lessons learned include starting early with engagement efforts across project stakeholder groups and planned flexibility to enable adaptations throughout the project lifecycle. CONCLUSION Each CSER project used more than 1 approach to engage with relevant stakeholders, resulting in numerous adaptations and tremendous value added throughout the full research lifecycle. Incorporation of community stakeholder insight improves the outcomes and relevance of genomic medicine research.
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Affiliation(s)
- Julianne M O'Daniel
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Sara Ackerman
- Department of Social & Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Lauren R Desrosiers
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
| | - Shannon Rego
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | - Sara J Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lonna Mollison
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Grace Byfield
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Grace Lamoure
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Nangel M Lindberg
- Center for Health Research Kaiser Permanente Northwest, Portland, OR
| | - Carmit K McMullen
- Center for Health Research Kaiser Permanente Northwest, Portland, OR
| | - Kathleen F Mittendorf
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Michelle A Ramos
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Catherine Sillari
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Ebony B Madden
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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21
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Riddle L, Karliner LS, Livaudais-Toman J, Guerra C, Roat CE, Rope AF, Wade A, Caruncho M, Zepp JM, Giang J, Wilfond BS, Joseph G. Development and evaluation of an exome sequencing training course for medical interpreters. Per Med 2022; 19:125-138. [PMID: 35171038 DOI: 10.2217/pme-2021-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: As genomic medicine reaches more diverse populations, there is an increased need for healthcare interpreters who understand and can effectively interpret genomics concepts. Methods: We designed a course for healthcare interpreters on exome sequencing to enhance their preparedness for genomic results disclosure appointments in the Cancer Health Assessments Reaching Many (CHARM) study and beyond. The course was evaluated via pre/post surveys and qualitative interviews. Results: 23 interpreters completed the course; 87% rated it as excellent/very good. Improved pre/post confidence interpreting for genetics appointments was statistically significant; pre/post knowledge was not. Interviews highlighted the need for more discussion time. Conclusion: While the course increased confidence interpreting for exome sequencing results appointments, suggested modifications could enhance knowledge and retention of key concepts.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Leah S Karliner
- Department of Medicine, Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Claudia Guerra
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Cynthia E Roat
- National Consultant & Trainer on Language Access in Health Care, Seattle, WA 98133, USA
| | - Alan F Rope
- Genome Medical, South San Francisco, CA 94080, USA
- Department of Translational & Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Amy Wade
- LanguageLine Solutions, Monterey, CA 93940, USA
| | - Mikaella Caruncho
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jamilyn M Zepp
- Department of Translational & Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Jessica Giang
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98105, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Galen Joseph
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
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22
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Choy P, Lewis T, Flores S, Sabacan L, Thannickal H, Goodman S, Shieh Y, Madlensky L, Tice JA, Ziv E, Eklund M, Blanco A, Tong B, Goodman D, Anderson N, Harvey H, Fors S, Park HL, Petruse A, Stewart S, Raouf S, Wernisch J, Koenig B, Kaplan C, Hiatt R, Wenger N, Lee V, Heditsian D, Brain S, Moorehead D, Parker BA, Borowsky A, Anton-Culver H, Naeim A, Kaster A, van 't Veer L, LaCroix AZ, Olopade OI, Sheth D, Garcia A, Lancaster R, James J, Joseph G, Study W, Fiscallini AS, Esserman L. Abstract P5-19-01: The impact of streamlined processes and patient-directed messaging to improve enrollment in a remote, pragmatic clinical trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-19-01] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background Recent advances in technology have made it possible to conduct remote clinical trials that allow individuals to participate from home with comfort, privacy, and ease. Despite these advances, challenges persist in running remote trials, such as survey question redundancies, lack of patient-initiated data-sharing tools, and unclear patient communication around critical enrollment steps. The Women Informed to Screen Depending on Measures of risk (WISDOM) Study is a pragmatic, preference-tolerant randomized control breast cancer screening trial comparing personalized risk-based screening to traditional, annual screening. The study population includes women ages 40-74 without a history of breast cancer or DCIS. Since 2016, study enrollment has been available to all women in the U.S. who meet study eligibility criteria. Since October 2020, WISDOM has implemented multiple strategies to improve participant experience: participant-initiated data-sharing tools and clear participant messaging. This abstract presents the efficacy of these interventions as they relate to increasing patient enrollment in remote, pragmatic clinical trials. Methods The WISDOM Study online enrollment process includes registration, participant study arm selection or randomization, online consent, and enrollment (submission of multiple study surveys over a secure, online platform). Barriers to online enrollment were uncovered through an internally-conducted needs assessment of participants who enrolled between 2019-2020, and participant feedback obtained through phone interviews conducted by WISDOM’s embedded ethics study. Improvements to our online enrollment procedures were executed in October 2020 and included: improving the clarity of study arm selection options, streamlining data collection surveys, and enacting a secure, patient-initiated online data-sharing tool and an online portal feature with auto-launch of critical information. Study metrics were obtained through Google Analytics and Salesforce. Results Prior to the end of 2020, only 62% of the 30,046 participants who registered for the WISDOM Study completed study enrollment. After improving the enrollment process, of the 5,334 participants registered for the study between Jan-June 2021, 69% completed the enrollment process finishing both the online consent and survey forms. Conversion from consent to enrollment went from 78% in January 2020 to 93% in June 2021. Currently, 56% participants complete enrollment in one day. Streamlining online patient questionnaires led to an increase in completion rates, with 75% of participants completing their yearly surveys, compared to 59% prior to April 2021. A secure patient upload feature for data sharing led to 1,054 participants successfully sharing their mammogram reports with WISDOM between March - June 2021. Previously, mammogram reports were missing for 20% of enrolled participants. This feature has enabled WISDOM to process 300 additional mammogram reports per month. Integration of an auto-launch feature in the participant’s portal in Feb 2021 has led to a 17% increase in participants viewing their screening recommendations in Yr 1. Prior to auto-launch, only 59% (n=6328) of Yr 1 screening recommendations and 61% (n=3681) of genetic testing reports were viewed by participants. Since implementation, the numbers increased to 78% (n=8406) and 85% (n=5160), respectively. Conclusions. Streamlining data to the most essential elements, and minimizing the steps required to share clinical documents, complete questionnaires and open key study notification is essential to improving enrollment rates in virtual, pragmatic trials. Patient-initiated data-sharing tools such as the ability for participants to share documents through secure, online portals is one example of success.
Citation Format: Patricia Choy, Tomiyuri Lewis, Stephanie Flores, Leah Sabacan, Halle Thannickal, Steffanie Goodman, Yiwey Shieh, Lisa Madlensky, Jeffrey A. Tice, Elad Ziv, Martin Eklund, Amie Blanco, Barry Tong, Deborah Goodman, Nancy Anderson, Heather Harvey, Steele Fors, Hannah Lui Park, Antonia Petruse, Skye Stewart, Samrrah Raouf, Janet Wernisch, Barbara Koenig, Celia Kaplan, Robert Hiatt, Neil Wenger, Vivian Lee, Diane Heditsian, Susie Brain, Dolores Moorehead, Barbara A Parker, Alexander Borowsky, Hoda Anton-Culver, Arash Naeim, Andrea Kaster, Laura van 't Veer, Andrea Z LaCroix, Olufunmilayo I. Olopade, Deepa Sheth, Agustin Garcia, Rachel Lancaster, Jennifer James, Galen Joseph, Wisdom Study, Athena Breast Health Network Investigators and Advocates, Allison Stover Fiscallini, Laura Esserman. The impact of streamlined processes and patient-directed messaging to improve enrollment in a remote, pragmatic clinical trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-19-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elad Ziv
- UC San Francisco, San Francisco, CA
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23
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KA. Corrigendum to “Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations” [Contemporary Clinical Trials 106 (2021) 106432]. Contemp Clin Trials 2022; 114:106682. [DOI: 10.1016/j.cct.2022.106682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Pasick RJ, Guerra C, Flores SR, Joseph G. Abstract PO-051: Blending research paradigms and methods to compare 3 modes of cancer genetic counseling with diverse public hospital patients: Insights from case studies. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-051] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Genetic counseling (GC) and testing for hereditary breast/ovarian cancer (HBOC) is concentrated in elite medical centers and not offered in most public hospitals despite comparable risk across income levels. GC may be extended remotely by phone or video to patients in low resource settings, but the benefits and harms of these modes for these patients are unknown. Methods: We conducted a multicenter partially randomized preference noninferiority trial in 3 public hospitals to compare the effectiveness of 3 GC modes (in-person, phone, video) among 679 diverse patients at high-risk for HBOC. To answer some of our most important questions (e.g. How engaged are patients with counselors and how does that affect outcomes? What about the GC affects key message recall? How do patients' life/health contexts affect GC impact? How do these dynamics differ by GC mode?), we compiled 23 case studies (CS) for a multifaceted understanding of patient context, intended to reveal influences that may be subtle, complex, and not accessible from individual self-report. The main trial outcome was presented at AACR 2020; here we report the case studies methods and findings. CS participants had consented to audio-recording their GC sessions; agreed to be contacted for further research during the final trial survey; and had been offered genetic testing but did not have results at the time of the in-depth CS interview. An iterative analytic process integrated and summarized qualitative and quantitative data from surveys, interviews, genetic counselor reflections and audio recordings for each case including: patient demographics, health literacy rating, GC mode; GC session duration, key points, and engagement; genetic counselor reflections; interview highlights; general conclusions about that case; conclusions based on mode; patient quotes; and an integrated conclusion from all the data elements. Results: Our randomized trial produced equivalent outcomes across 3 GC modes. But our case studies revealed critical differences including higher quality engagement and trust-building via in-person and video counseling compared with phone, where distractions and brevity were common. While more patients opted for the convenience of phone, and for many it was their only option due to work and other demands, those counseled by phone were least likely to complete genetic testing when it was offered. Patients in all modes struggled with information recall. Conclusions: GC by phone is an important source of access for low-income patients but research should strive for higher quality. GC by video holds promise but availability is a concern. For both remote modes, easy access to testing is required. Strategies to improve information recall are needed in all modes. Research using quantitative cognitive ascertainment should include mixed methods for a more multifaceted in-depth exploration that yields rich real-world insights.
Citation Format: Rena J. Pasick, Claudia Guerra, Selina R. Flores, Galen Joseph. Blending research paradigms and methods to compare 3 modes of cancer genetic counseling with diverse public hospital patients: Insights from case studies [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-051.
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Affiliation(s)
- Rena J. Pasick
- 1University of California, San Francisco, San Francisco, CA,
| | - Claudia Guerra
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
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25
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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26
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James JE, Riddle L, Koenig BA, Joseph G. The limits of personalization in precision medicine: Polygenic risk scores and racial categorization in a precision breast cancer screening trial. PLoS One 2021; 16:e0258571. [PMID: 34714858 PMCID: PMC8555816 DOI: 10.1371/journal.pone.0258571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/01/2021] [Indexed: 01/10/2023] Open
Abstract
Population-based genomic screening is at the forefront of a new approach to disease prevention. Yet the lack of diversity in genome wide association studies and ongoing debates about the appropriate use of racial and ethnic categories in genomics raise key questions about the translation of genomic knowledge into clinical practice. This article reports on an ethnographic study of a large pragmatic clinical trial of breast cancer screening called WISDOM (Women Informed to Screen Depending On Measures of Risk). Our ethnography illuminates the challenges of using race or ethnicity as a risk factor in the implementation of precision breast cancer risk assessment. Our analysis provides critical insights into how categories of race, ethnicity and ancestry are being deployed in the production of genomic knowledge and medical practice, and key challenges in the development and implementation of novel Polygenic Risk Scores in the research and clinical applications of this emerging science. Specifically, we show how the conflation of social and biological categories of difference can influence risk prediction for individuals who exist at the boundaries of these categories, affecting the perceptions and practices of scientists, clinicians, and research participants themselves. Our research highlights the potential harms of practicing genomic medicine using under-theorized and ambiguous categories of race, ethnicity, and ancestry, particularly in an adaptive, pragmatic trial where research findings are applied in the clinic as they emerge. We contribute to the expanding literature on categories of difference in post-genomic science by closely examining the implementation of a large breast cancer screening study that aims to personalize breast cancer risk using both common and rare genomic markers.
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Affiliation(s)
- Jennifer Elyse James
- Institute for Health and Aging, University of California, San Francisco, California, United States of America
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, California, United States of America
| | - Barbara Ann Koenig
- Institute for Health and Aging, University of California, San Francisco, California, United States of America
- Department of Humanities and Social Sciences, University of California, San Francisco, California, United States of America
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, California, United States of America
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27
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Lee R, Frick M, Joseph G, Guerra C, Stewart S, Kaplan C, Dixit N, Tsoh JY, Flores S, Pasick RJ. Research to reduce inequities in cancer risk services: Insights for remote genetic counseling in a pandemic and beyond. J Genet Couns 2021; 30:1292-1297. [PMID: 34687478 PMCID: PMC8657358 DOI: 10.1002/jgc4.1525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Robin Lee
- University of California, San Francisco, San Francisco, California, USA
| | - Miya Frick
- University of California, San Francisco, San Francisco, California, USA
| | - Galen Joseph
- University of California, San Francisco, San Francisco, California, USA
| | - Claudia Guerra
- University of California, San Francisco, San Francisco, California, USA
| | - Susan Stewart
- University of California, Davis, Davis, California, USA
| | - Celia Kaplan
- University of California, San Francisco, San Francisco, California, USA
| | - Niharika Dixit
- University of California, San Francisco, San Francisco, California, USA
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California, USA
| | - Selena Flores
- University of California, San Francisco, San Francisco, California, USA
| | - Rena J Pasick
- University of California, San Francisco, San Francisco, California, USA
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Lindberg NM, Gutierrez AM, Mittendorf KF, Ramos MA, Anguiano B, Angelo F, Joseph G. Creating accessible Spanish language materials for Clinical Sequencing Evidence-Generating Research consortium genomic projects: challenges and lessons learned. Per Med 2021; 18:441-454. [PMID: 34448595 PMCID: PMC8438935 DOI: 10.2217/pme-2020-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2021] [Indexed: 01/31/2023]
Abstract
Aim: To increase Spanish speakers' representation in genomics research, accessible study materials on genetic topics must be made available in Spanish. Materials & methods: The Clinical Sequencing Evidence-Generating Research consortium is evaluating genome sequencing for underserved populations. All sites needed Spanish translation of recruitment materials, surveys and return of results. Results: We describe our process for translating site-specific materials, as well as shared measures across sites, to inform future efforts to engage Spanish speakers in research. Conclusion: In translating and adapting study materials for roughly 1000 Spanish speakers across the USA, and harmonizing translated measures across diverse sites, we overcame numerous challenges. Translation should be performed by professionals. Studies must allocate sufficient time, effort and budget to translate and adapt participant materials.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Amanda M Gutierrez
- Baylor College of Medicine Center for Medical Ethics & Health Policy, One Baylor Plaza, Suite 310D, Houston, TX 77030, USA
| | - Kathleen F Mittendorf
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Michelle A Ramos
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA
| | - Beatriz Anguiano
- University of California, San Francisco (UCSF) Program in Bioethics, 3333 California Ave (suite 340), San Francisco, CA 94606, USA
| | - Frank Angelo
- CSER Coordinating Center, University of Washington, Division of Medical Genetics, Health Sciences Building, K-253 Box 357720 Seattle, WA 98195, USA
| | - Galen Joseph
- University of California San Francisco Department of Humanities & Social Sciences, 1450 3rd Street, Rm. 551 San Francisco, CA 94143, USA
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Almeida R, Lopez-Macha A, Dugatkin T, Joseph G, Duron Y, Hurtado de Mendoza A, D. Graves K, Fejerman L. Community research collaboration to develop a promotores-based hereditary breast cancer education program for Spanish-speaking Latinas. Health Educ Res 2021; 36:319-336. [PMID: 34113985 PMCID: PMC9115327 DOI: 10.1093/her/cyab011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Breast cancer (BC) is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed at later stages, receive poorer quality care and have a higher risk of mortality than non-Latina White (NLW) women. Among women with a genetic predisposition to hereditary BC, genetic counseling can be beneficial. Latinas participate in genetic counseling at lower rates than NLW women. The goal of this study was to develop comprehensive, culturally appropriate materials for community health educators (promotores)-led hereditary BC education program for Spanish-speaking Latinas. We developed the curriculum through feedback from 7 focus groups, with a total of 68 participants (35 promotores and 33 community members). We used a mixed-methods approach that relied on quantitative analysis of survey questions and qualitative content analysis of the focus groups transcripts. Pre and post promotores' training survey responses suggested improvement in the promotores' cancer-related knowledge. Themes that emerged from the qualitative analyses were (i) barriers to health education and/or care; (ii) importance of educating the Latino community about BC and genetics and (iii) role of the promotores. Future research will further evaluate the impact of the program in promotores' knowledge and community members' screening behaviors.
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Affiliation(s)
| | | | | | - Galen Joseph
- University of California, San Francisco, CA, USA
| | | | | | | | - Laura Fejerman
- University of California, San Francisco, CA, USA
- University of California, Davis, San Francisco, CA, USA
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KAB. Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations. Contemp Clin Trials 2021; 106:106432. [PMID: 33984519 PMCID: PMC8336568 DOI: 10.1016/j.cct.2021.106432] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Advances in the application of genomic technologies in clinical care have the potential to increase existing healthcare disparities. Studies have consistently shown that only a fraction of eligible patients with a family history of cancer receive recommended cancer genetic counseling and subsequent genetic testing. Care delivery models using pre-test and post-test counseling are not scalable, which contributes to barriers in accessing genetics services. These barriers are even more pronounced for patients in historically underserved populations. We have designed a multimodal intervention to improve subsequent cancer surveillance, by improving the identification of patients at risk for familial cancer syndromes, reducing barriers to genetic counseling/testing, and increasing patient understanding of complex genetic results. We are evaluating this intervention in two large, integrated healthcare systems that serve diverse patient populations (NCT03426878). The primary outcome is the number of diagnostic (hereditary cancer syndrome) findings. We are examining the clinical and personal utility of streamlined pathways to genetic testing using electronic medical record data, surveys, and qualitative interviews. We will assess downstream care utilization of individuals receiving usual clinical care vs. genetic testing through the study. We will evaluate the impacts of a literacy-focused genetic counseling approach versus usual care genetic counseling on care utilization and participant understanding, satisfaction, and family communication. By recruiting participants belonging to historically underserved populations, this study is uniquely positioned to evaluate the potential of a novel genetics care delivery program to reduce care disparities.
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Affiliation(s)
- Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | | | | | - Michael O Dorschner
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sandra Soo Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, 630 West 168(th) St, PH15E-1525, New York, NY 10032, USA
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, 777 Bannock Denver, CO 80204, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Leslie S Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Bradley A Rolf
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Alan F Rope
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA; Genome Medical, 701 Gateway Blvd, Suite 380, San Francisco, CA 94080, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
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Riddle L, Amendola LM, Gilmore MJ, Guerra C, Biesecker B, Kauffman TL, Anderson K, Rope AF, Leo MC, Caruncho M, Jarvik GP, Wilfond B, Goddard KAB, Joseph G. Development and early implementation of an Accessible, Relational, Inclusive and Actionable approach to genetic counseling: The ARIA model. Patient Educ Couns 2021; 104:969-978. [PMID: 33549385 PMCID: PMC8881934 DOI: 10.1016/j.pec.2020.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the training and early implementation of the ARIA model of genetic counseling (Accessible, Relational, Inclusive, Actionable). METHODS As part of the Cancer Health Assessments Reaching Many (CHARM) study, an interdisciplinary workgroup developed the ARIA curriculum and trained genetic counselors to return exome sequencing results using the ARIA model. CURRICULUM The ARIA curriculum includes didactic elements, discussion, readings, role plays, and observations of usual care genetic counseling sessions. The ARIA model provides the skills and strategies needed for genetic counseling to be accessible to all patients, regardless of prior knowledge or literacy level; involves appropriate psychological and social counseling without overwhelming the patient with information; and leaves the patient with clear and actionable next steps. CONCLUSION With sufficient training and practice, the ARIA model appears to be feasible, with promise for ensuring that genetic counselors' communication is accessible, relational, inclusive and actionable for the diverse patients participating in genomic medicine. PRACTICE IMPLICATIONS ARIA offers a coherent set of principles and strategies for effective communication with patients of all literacy levels and outlines specific techniques to practice and incorporate these skills into routine practice. The ARIA model could be integrated into genetic counseling training programs and practice, making genetic counseling more accessible and meaningful for all patients.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Claudia Guerra
- Department of General Internal Medicine, University of California, San Francisco, 1450 3rd St. Box 0128, San Francisco, CA 94158, USA
| | | | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Katherine Anderson
- Denver Health and Hospital Authority, MC 3150, 777 Bannock, Denver, CO 80204, USA
| | - Alan F Rope
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, M/S JMB-6, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
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Biesecker BB, Lillie SE, Amendola LM, Donohue KE, East KM, Foreman AKM, Gilmore MJ, Greve V, Liangolou B, O'Daniel JM, Odgis JA, Rego S, Rolf B, Scollon S, Suckiel SA, Zepp J, Joseph G. A review and definition of 'usual care' in genetic counseling trials to standardize use in research. J Genet Couns 2021; 30:42-50. [PMID: 33278053 PMCID: PMC7882019 DOI: 10.1002/jgc4.1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
The descriptor 'usual care' refers to standard or routine care. Yet, no formal definition exists. The need to define what constitutes usual care arises in clinical research. Often one arm in a trial represents usual care in comparison with a novel intervention. Accordingly, usual care in genetic counseling research appears predominantly in randomized controlled trials. Recent standards for reporting genetic counseling research call for standardization, but do not address usual care. We (1) inventoried all seven studies in the Clinical Sequencing Evidence-Generating Consortium (CSER) about how genetic counseling was conceptualized, conducted, and whether a usual care arm was involved; (2) conducted a review of published randomized control trials in genetic counseling, comparing how researchers describe usual care groups; and (3) reviewed existing professionally endorsed definitions and practice descriptions of genetic counseling. We found wide variation in the content and delivery of usual care. Descriptions frequently detailed the content of usual care, most often noting assessment of genetic risk factors, collecting family histories, and offering testing. A minority included addressing psychological concerns or the risks versus benefits of testing. Descriptions of how care was delivered were vague except for mode and type of clinician, which varied. This significant variation, beyond differences expected among subspecialties, reduces the validity and generalizability of genetic counseling research. Ideally, research reflects clinical practice so that evidence generated can be used to improve clinical outcomes. To address this objective, we propose a definition of usual care in genetic counseling research that merges common elements from the National Society of Genetic Counselors' practice definition, the Reciprocal Engagement Model, and the Accreditation Council for Genetic Counselors' practice-based competencies. Promoting consistent execution of usual care in the design of genetic counseling trials can lead to more consistency in representing clinical care and facilitate the generation of evidence to improve it.
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Affiliation(s)
- Barbara B Biesecker
- Genomics, Bioinformatics and Translation, RTI International, Washington, DC, USA
| | - Sarah E Lillie
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Laura M Amendola
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Katherine E Donohue
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Veronica Greve
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | | | - Jacqueline A Odgis
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shannon Rego
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bradley Rolf
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sabrina A Suckiel
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamilyn Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
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Kraft SA, Porter KM, Duenas DM, Guerra C, Joseph G, Lee SSJ, Shipman KJ, Allen J, Eubanks D, Kauffman TL, Lindberg NM, Anderson K, Zepp JM, Gilmore MJ, Mittendorf KF, Shuster E, Muessig KR, Arnold B, Goddard KAB, Wilfond BS. Participant Reactions to a Literacy-Focused, Web-Based Informed Consent Approach for a Genomic Implementation Study. AJOB Empir Bioeth 2021; 12:1-11. [PMID: 32981477 PMCID: PMC7785634 DOI: 10.1080/23294515.2020.1823907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jake Allen
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Donna Eubanks
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Nangel M Lindberg
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | | | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Shuster
- Research Data and Analysis Center, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Briana Arnold
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Riddle L, Amendola LM, Gilmore MJ, Rolf B, Zepp J, Guerra C, Biesecker B, Caruncho M, Anderson KP, Rope AF, Kauffman TL, Lewis H, Kraft SA, Duenas DM, Wilfond B, Goddard KA, Joseph G. Abstract PO-050: Reducing disparities in genomic medicine using a literacy-focused genetic counseling model for cancer risk assessment. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-050] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Genetic and genomic testing is reaching more people than ever, yet disparities in access to and application of hereditary cancer screening remain. Further, with the advent of lower cost sequencing, the amount and complexity of information that is conveyed to patients, including secondary results, has increased. As part of the Clinical Sequencing Evidence-Generating Research (CSER) consortium, the Cancer Health Assessments Reaching Many (CHARM) study implemented a hereditary cancer risk assessment program for healthy adults aged 18-49. Participants were recruited in English and Spanish from two primary care settings (Kaiser Permanente Northwest and Denver Health). Participants underwent clinical exome sequencing and were randomized to receive their test results via usual care or a “literacy-focused” genetic counseling approach (n=845). Genetic counselors in the literacy- focused arm received in-depth training to adapt and apply evidence-based methods for effective communication with individuals of all literacy levels. We hypothesized that the literacy-focused approach would be non-inferior to usual care genetic counseling and generate higher satisfaction, engagement, and understanding of and adherence to recommended care. We also collected qualitative data to explore the experience of receiving exome sequencing results in this setting. Here, we present findings from qualitative interviews with participants conducted within a month (n=35) and again at 6 months (n=15) after receiving results, including: pathogenic cancer risk variants, medically actionable secondary findings and carrier results; variants of uncertain significant (VUS) in cancer genes; and negative results. The mean age of participants was 33. 72% spoke English and 75% were considered medically underserved by CHARM criteria. Participants in both trial arms expressed overall satisfaction; however, some participants in the literacy-focused arm indicated that specific elements of the approach, such as teach-back and plain language, helped facilitate their understanding, while some in the usual care arm said the information was overly technical. Younger participants in both arms, whose sequencing results will not be clinically actionable for many years, reported less worry and recalled fewer details about their results than older participants. While participants recognized the utility of positive results for family, at six months only some had spoken with them about testing, and few relatives had undergone cascade testing offered by CHARM. Genomic medicine requires clear communication of disease risk and prevention recommendations. Our qualitative findings suggest that the literacy-focused approach to genetic counseling can help facilitate patient understanding of cancer and other genomic risk. These results can guide effective disclosure of sequencing results and have implications for training clinical genetics professionals in the provision of equitable care for diverse patients.
Citation Format: Leslie Riddle, Laura M. Amendola, Marian J. Gilmore, Brad Rolf, Jamilyn Zepp, Claudia Guerra, Barbara Biesecker, Mikaella Caruncho, Katherine P. Anderson, Alan F. Rope, Tia L. Kauffman, Hannah Lewis, Stephanie A. Kraft, Devan M. Duenas, Benjamin Wilfond, Katrina A.B. Goddard, Galen Joseph. Reducing disparities in genomic medicine using a literacy-focused genetic counseling model for cancer risk assessment [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-050.
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Affiliation(s)
- Leslie Riddle
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | - Brad Rolf
- 2University of Washington, Seattle, WA,
| | - Jamilyn Zepp
- 3Kaiser Permanente Center for Health Research, Portland, OR,
| | - Claudia Guerra
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | | | | | - Tia L. Kauffman
- 3Kaiser Permanente Center for Health Research, Portland, OR,
| | - Hannah Lewis
- 7Seattle Children's Research Institute, Seattle, WA
| | | | | | | | | | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
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Lee R, Frick M, Kaplan C, Joseph G, Tsoh J, Flores S, Dixit N, Cedermaz H, Wang L, Khoury A, Campbell B, Pasick R, Guerra CS, Stewart SL. Abstract PO-012: Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-012] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction While still low, diversity among clinical trial participants has improved in recent years due to efforts to eliminate health disparities. Here we present and endeavor to explain participation rates in our multicenter partially randomized preference noninferiority trial comparing the effectiveness of phone, video, and in person genetic counseling among high-risk English-, Spanish-, and Chinese-speaking patients. Methods High-risk patients were identified using a family history screener in clinics and via physician referrals. After reviewing forms received, bilingual/bicultural clinical research coordinators (CRC) called patients considered eligible in their preferred language (English, Spanish or Cantonese, Mandarin or Toisanese). Patients were informed that their hospital was conducting the study in conjunction with an academic institution. The CRC went over each patient’s family history of cancer to confirm eligibility and to explain the study components, including free genetic counseling. Because previous research had significant refusals due to patients’ preferences for a single mode, our consented patients were asked if they would accept random assignment to phone, video, or in person counseling or if they had a strong preference. Patients who declined were asked their reasons. Results Out of 1,403 patients reached (70% English-, 26% Spanish-, and 3% Chinese- speaking), 86% agreed to participate. The highest acceptance rate was among Spanish-speakers (94%), followed by English-speakers (83%) and Chinese-speakers (67%). Among the 201 patients who declined, 49% did so upon contact, while 51% declined after eligibility was confirmed. Reasons for declining are available for 71% of decliners as follows: 22% not interested; 19% no time; 10% cited no benefit them or family members; 7% did not want to talk about cancer; 7% had too many other medical issues; and 6% provided a range of other reasons. Discussion and Conclusions We believe that our study’s high initial participation rate for patients contacted was due to the purpose which was particularly meaningful to those with a family history of cancer. Also, patients trusted their own hospitals which co- sponsored the study. It was helpful that providers in the 3 public hospitals strongly supported the research which provided much needed genetic counseling and pursued questions important to access to genetic services. Importantly, our study design addressed significant known barriers to minority and low SES participation in clinical trials through the use of bilingual/bicultural investigators, multi-language study materials, and strong, positive working relationships with gatekeeper medical and clinic support staff. Reasons given for declining may indicate the existence of a socio-economic structural ceiling for participation due to patient vulnerabilities and societal burdens, causes outside the investigative scope of our study that are likely to continue to hamper efforts to improve participation if not addressed.
Citation Format: Robin Lee, Miya Frick, Celia Kaplan, Galen Joseph, Janice Tsoh, Selina Flores, Niharika Dixit, Heather Cedermaz, Lly Wang, Amal Khoury, Brittany Campbell, Rena Pasick, Claudia S. Guerra, Susan L. Stewart. Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-012.
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Affiliation(s)
- Robin Lee
- 1University of California, San Francisco, San Francisco, CA,
| | - Miya Frick
- 1University of California, San Francisco, San Francisco, CA,
| | - Celia Kaplan
- 1University of California, San Francisco, San Francisco, CA,
| | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
| | - Janice Tsoh
- 1University of California, San Francisco, San Francisco, CA,
| | - Selina Flores
- 1University of California, San Francisco, San Francisco, CA,
| | - Niharika Dixit
- 1University of California, San Francisco, San Francisco, CA,
| | - Heather Cedermaz
- 2Hematology/Oncology, Contra Costa Heath Services, Martinez, CA,
| | - Lly Wang
- 2Hematology/Oncology, Contra Costa Heath Services, Martinez, CA,
| | - Amal Khoury
- 3Highland Hospital, Alameda Health System, Oakland, CA,
| | | | - Rena Pasick
- 1University of California, San Francisco, San Francisco, CA,
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Pasick RJ, Stewart SL, Lee R, Guerra C, Kaplan C, Joseph G, Flores S, Tsoh J, Dixit N, Frick M, Cedermaz H, Wong L, Khoury A, Campbell B. Abstract PO-051: Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-051] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
In public health settings, where availability of genetic counseling (GC) and testing for hereditary breast and ovarian cancer is limited, telehealth could expand access to academic centers where these services are concentrated. However, little is known about the effectiveness of remote modes for ethnically diverse and low health literacy patients. Methods. From 2017-20 UCSF researchers partnered with 3 public hospitals to conduct a partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients with strong personal and/or family history of cancer. Participants received GC in person, by phone, or via video. Pre- and post-GC telephone surveys measured study outcomes: knowledge, cancer- specific distress, decisional conflict, risk perception, and satisfaction. A subset of 23 participants was recruited for case studies (CS) to elucidate quantitative findings. CS integrated patient and counselor in-depth interviews, GC session transcripts, and survey and tracking data for a multi-dimensional understanding of each individual’s GC experience. Results. Among 23,633 family history forms collected, 1,574 patients were eligible; 1404 were reached and 708 consented. Of 394 randomized, 322 attended GC and 312 completed the final survey. After GC, mean knowledge scores increased, and cancer-specific distress and decisional conflict decreased overall.
Counseling attendance varied significantly by assigned mode (75% via video at a clinic, 77% in person, and 92% by phone), but the modes yielded noninferior outcomes. Respondents overwhelmingly rated all modes as “very convenient” and satisfaction with counseling as “very high.” Compared with baseline, knowledge increased significantly regardless of mode. However, this increase was significantly less for African Americans and for those with less education (with each adjusted for the other) across all modes. Completion of genetic testing (GT) was the inverse of counseling attendance: 94% in person, 93% video, and 65% by phone. Case studies (CS) revealed the complexities of counseling public hospital patients. Phone patients valued the access despite connection issues, but phone appointments tended to be briefer, and qualitative interviews suggested that communication was less effective by phone. While many phone patients said they would not be able to access GC any other way, several felt they would get more out it in person. Importantly, GT was offered on the spot to in-person patients while some counseled by phone had second thoughts and other barriers. CS of video counseling found benefits similar to in-person GC such as use of visual cues and formation of meaningful connections. Conclusion. Our findings indicate that GC can be delivered to high-risk public hospital patients remotely by phone, video, or in-person in order to fill a gap in access to critical genetic services. Further research is needed to achieve optimal outcomes for all patients and to increase the rate of testing for those counseled by phone.
Citation Format: Rena J Pasick, Susan L. Stewart, Robin Lee, Claudia Guerra, Celia Kaplan, Galen Joseph, Selina Flores, Janice Tsoh, Niharika Dixit, Miya Frick, Heather Cedermaz, Lily Wong, Amal Khoury, Brittany Campbell. Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-051.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lily Wong
- 3Contra Costa Health Care System, Martinez, CA,
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Feigelson HS, Mittendorf KF, Kauffman TL, Anderson K, Okuyama S, Wilfond B, Jarvik GP, Amendola LM, McMullen C, Lynch F, Eubanks D, Shuster E, Allen J, Kraft SA, Joseph G, Lee SSJ, Goddard KA. Abstract PR02: Using web-based tools to assess familial cancer risk in diverse populations. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.modpop19-pr02] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: The Cancer Health Risk Assessments Reaching Many (CHARM) study (NCT03426878) aims to increase access to genetic testing for hereditary cancer in low-income, low-literacy, and minority populations (hereafter referred to as “underserved”). To implement the study, we have capitalized on the availability of electronic medical record (EMR) systems, developed innovative web-based tools, and designed a novel telemedicine protocol for return of clinical genetic testing results.
Methods: Patients aged 18-49 years are recruited from two centers: Kaiser Permanente Northwest (KPNW; an integrated health care system in Portland, OR) and Denver Health (DH; a federally qualified health care center in Denver, CO). Specific protocols were developed to identify potentially eligible patients from the EMR and invite them to complete a web-based family history assessment. KPNW patients were recruited using email, text messaging, and in-clinic booths; DH patients were recruited via mail, phone, and provider referral. Validated risk assessment tools for Lynch syndrome (PREMM5) and heredity breast and ovarian cancer syndrome (B-RST) were adapted for our low-literacy and bilingual (English and Spanish) target population. Genetic testing is offered to patients with greater than average risk for hereditary cancer, or where risk cannot be assessed because of unknown family history or limited family structure. Eligible patients review a multipart, multimedia online consent. Those who consent to participate provide a saliva sample for clinical exome sequencing. Genetic counselors return results by telephone using traditional (usual care active comparator) or modified, communication-focused (experimental) counseling for pathogenic variants, likely pathogenic variants, and select variants of uncertain significance in 39 genes related to cancer risk, pathogenic variants in 79 genes related to medically actionable secondary findings, and 14 genes related to carrier status.
Results: In the first four months of recruitment, 258 patients have completed the risk assessment tool (48% are underserved). Of those, 180 (70%) had greater than average risk of hereditary cancer (or limited family history information) and were invited to participate (53% were underserved); 86% of underserved patients and 78% of patients who do not meet criteria for the underserved category have consented. The vast majority of participants complete enrollment without assistance from study staff, and in-person visits are not required for participation. Telephone genetic test result disclosure will begin in December 2018.
Conclusions: We have successfully developed online tools for cancer risk assessment that are accessible to underserved and low-literacy populations. These tools may be a cost-effective approach for improving the capture of family history data in the EMR. It does not require a provider to gather the information and the patient gets immediate feedback on results of the risk assessment and appropriate next steps.
This abstract is also being presented as Poster A37.
Citation Format: Heather Spencer Feigelson, Kathleen F. Mittendorf, Tia L. Kauffman, Katherine Anderson, Sonia Okuyama, Benjamin Wilfond, Gail P. Jarvik, Laura M. Amendola, Carmit McMullen, Fances Lynch, Donna Eubanks, Elizabeth Shuster, Jake Allen, Stephanie A. Kraft, Galen Joseph, Sandra Soo-Jin Lee, Katrina A.B. Goddard. Using web-based tools to assess familial cancer risk in diverse populations [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr PR02.
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Affiliation(s)
| | | | - Tia L. Kauffman
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | | | | | | | | | - Carmit McMullen
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | - Fances Lynch
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | - Donna Eubanks
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | - Jake Allen
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | - Galen Joseph
- 6University of California, San Francisco, San Francisco, CA,
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Campbell B, Harris M, Rugo H, Joseph G, Pasick R. Abstract A006: Can expert second opinions reduce treatment disparities for African American breast cancer patients? An exploratory study. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a006] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: The excess breast cancer mortality among African Americans is well documented, and insufficient treatment quality in low-resource settings is a key cause. The second opinion could connect patients with the best available medical knowledge. We explored the extent to which treatment plans can be improved through consultations at NCI-designated Comprehensive Cancer Centers (CCC) that deliver the latest treatments, and to describe the experience of patients and consulting clinicians.
Methods: Eligible patients, those who self-identify as African American and have concerns about breast cancer, were recruited from communities and clinics. The research grant covered the cost of consultations. Ethnographic methods (audio-recorded observations and in-depth interviews) were used to ascertain consultation impacts. Data sources were transcripts from consultations; post-consult patient interviews, once following the consultation and again after treatment decisions were made; and one clinician interview per consultation. Standard grounded theory analytic methods were used.
Results: A total of 17 consultations were conducted with 14 female patients ages 32-71. Treating health care institutions were public hospitals, an integrated health care delivery system, an academic medical center, private not-for-profit community hospitals, and a private cancer center. Patients sought consults for concerns such as the possibility that a breast change was cancer, diagnosis of lobular carcinoma in situ (LCIS), treatment plans for invasive breast cancers at every stage, management of metastases, and prevention of recurrence. Some changes were recommended in every case, from simple routine procedures to major transformations. For example: An LCIS patient was advised to start an aromatase inhibitor, have yearly mammograms and MRIs, and to change her diet.A patient with advanced disease was advised to add CDK 4/6 inhibitor to her treatment.Whether and how to administer complex intrathecal chemotherapy (injection into the space between the thin layers of tissue that cover the brain and spinal cord) was discussed for a young patient with brain metastases.A clinical trial and genetic testing were recommended to a Stage IV breast cancer patient.
Overall consulting doctors' proposals were adopted. Patients learned about their cancer, the benefits and limitations of their current treatment, and about clinical trials. They appreciated confirmation that they were receiving quality care or recommended changes. CCC clinicians were eager to help patients with the greatest needs.
Conclusions: Second opinion consultations can open communication channels between leading cancer experts and oncologists in low-resource settings, increasing prospects for equal treatment.
Citation Format: Brittany Campbell, Marion Harris, Hope Rugo, Galen Joseph, Rena Pasick. Can expert second opinions reduce treatment disparities for African American breast cancer patients? An exploratory study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A006.
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Affiliation(s)
| | | | - Hope Rugo
- 1University of California, San Francisco, San Francisco, CA,
| | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
| | - Rena Pasick
- 1University of California, San Francisco, San Francisco, CA,
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Pasick RJ, Campbell B, Rugo HS, Dillard C, Harris M, Joseph G. Abstract D078: Unlocking the vault: Can 2nd opinions by Comprehensive Cancer Center breast oncologists improve treatment quality for African Americans? Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-d078] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Research increasingly points to inadequate treatment as a factor in the excess breast cancer mortality experienced by African Americans. Likely causes include lack of guideline-concordant care, underuse of medical advances, and limited opportunities to participate in clinical trials and genetic counseling. African Americans are disproportionately affected because they are more likely to receive care in low-resource settings. Importantly, emerging research shows that NCI-designated Comprehensive Cancer Centers (CCCs) have the best cancer outcomes compared with other clinical settings - yet African Americans and Latinx are under-represented as patients in CCCs. It is as if the leading cancer clinicians and the resources at their disposal are locked in a vault inaccessible to those with the greatest need. We used ethnographic methods to explore the feasibility of and extent to which the simple mechanism of a CCC 2nd opinion can improve the quality of treatment offered to African American breast cancer patients receiving care in a range of other institutions. Through community outreach, 14 patients were recruited and 17 CCC consultations were conducted at no charge. Each visit was observed and audio-taped to capture the consulting oncologist’s recommendations. Patients were interviewed 3 weeks after the consultation and again up to 1 year later to document the impact of the consultation on their treatment. Consulting oncologists were also interviewed. Our findings reveal a variety of ways in which the CCC 2nd opinion substantially improved the quality of treatment for African American breast cancer patients. In all cases CCC clinicians offered important recommendations, from complete revision of a treatment plan to adding/changing medications, modifying the plan for monitoring, and/or improving management of side effects. Patients reported that all major recommendations were implemented by their treating clinicians. In one dramatic case, chemotherapy was failing to slow the growth a young public hospital patient’s stage 3 tumor associated with a P53 mutation. The CCC clinician recommended and advocated for an entirely different treatment. In remission two years later, the patient has had another child. To our knowledge, this is the first study to explore the CCC consultation as an intervention to reduce mortality disparities. It appears highly feasible to target CCC 2nd opinions to vulnerable patients at relatively low cost to the CCC. Many CCC clinicians are eager to see high-risk under-represented patients, and go beyond the consultation by communicating with treating clinicians and seeing patients more than once. Patients readily recognized the expertise of CCC clinicians and were deeply grateful for the opportunity. Based on this pilot study, the 2nd opinion concept warrants further testing via a randomized trial. Comprehensive Cancer Centers can and must take greater responsibility for disparities in their region through innovations that extend their expertise beyond their walls.
Citation Format: Rena J Pasick, Brittany Campbell, Hope S Rugo, Christen Dillard, Marion Harris, Galen Joseph. Unlocking the vault: Can 2nd opinions by Comprehensive Cancer Center breast oncologists improve treatment quality for African Americans? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D078.
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Guerra C, Lee R, Stewart SL, Kaplan C, Joseph G, Tsoh J, Dixit N, Cedermaz H, Kim J, Campbell J, Wang LX, Khoury A, Hellman-Wylie C, Pasick RJ. Abstract A034: Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-a034] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Genetic counseling (GC) for hereditary breast and ovarian cancer is available mainly in academic settings. Despite equal risk, most low income public hospital patients remain unaware and untested. Remote counseling may be a solution, but research has been limited to phone counseling for insured patients. Our study compares in-person, phone, and video conference GC among high-risk patients in 3 public hospitals to determine the comparative effectiveness of GC delivered across modes with regard to patients’ knowledge, cancer distress, decisional conflict, perceived stress, risk perception, satisfaction, and recall. We also assessed whether patients have a preference for counseling mode and how that affects outcomes. This report describes the study design and lessons learned regarding recruitment. We conducted a multicenter partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients assigned by randomization or patients´ preference to one of the three GC modes. High-risk patients were identified using a family history screener in clinics or by physician referral. Study staff verified risk by phone, invited participation, conducted informed consent, and administered a baseline survey. Enrollees were asked whether they could be randomized or if they preferred one GC mode. They were then given a GC appointment and called again within 2 weeks of counseling for a follow-up survey. Power calculations required 270 randomized patients. A total of 23,401 screener forms yielded 824 likely to be high-risk; 656 completed baseline surveys. Race/ethnic composition was 40% Latinx, 25% white, 19% African American, and 8% Asian. Of these, 531 were counseled, and 505 completed final surveys (283 from randomized patients). The majority (64%) of non-randomized patients chose counseling by phone, 33% chose in person, 3% chose video. • At every step, participation exceeded our projections, showing that diverse low-income patients were interested in participating in research that they deemed relevant. • Our greatest recruitment challenges were due more to settings than to patients. Collection of screeners varied greatly by month and/or clinic. Oncologists valued the risk services offered by the study, but intensive engagement was necessary with front-line staff/supervisors because of their job demands. • Partial randomization functioned well. Prior studies showed that many high-risk women refuse randomization for GC. Adding a preference arm necessitated a larger sample, but greater inclusiveness yields more generalizable findings. • Recruitment of Chinese-speaking patients was low (2.5%) due largely to structural barriers which we continue to explore. Practice-based safety net research presents numerous challenges that require close partnerships, extensive planning, and highly skilled staff capable of sensitive personnel engagement. The work is rewarded by real-world findings, the sine qua non in efforts to eliminate cancer disparities.
Citation Format: Claudia Guerra, Robin Lee, Susan L Stewart, Celia Kaplan, Galen Joseph, Janice Tsoh, Niharika Dixit, Heather Cedermaz, Jin Kim, Jane Campbell, Lily X Wang, Amal Khoury, Cindy Hellman-Wylie, Rena J Pasick. Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A034.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jin Kim
- 4Alameda County Medical Center, Oakland, CA, USA,
| | - Jane Campbell
- 3Contra Costa Regional Medical Ctr, Martinez, CA, USA,
| | - Lily X Wang
- 3Contra Costa Regional Medical Ctr, Martinez, CA, USA,
| | - Amal Khoury
- 5Alameda County Medical Center, Oakland, CA, USA
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Kraft SA, McMullen C, Lindberg NM, Bui D, Shipman K, Anderson K, Joseph G, Duenas DM, Porter KM, Kauffman TL, Koomas A, Ransom CL, Jackson P, Goddard KAB, Wilfond BS, Lee SSJ. Integrating stakeholder feedback in translational genomics research: an ethnographic analysis of a study protocol's evolution. Genet Med 2020; 22:1094-1101. [PMID: 32089547 PMCID: PMC7275883 DOI: 10.1038/s41436-020-0763-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study describes challenges faced while incorporating sometimes conflicting stakeholder feedback into study design and development of patient-facing materials for a translational genomics study aiming to reduce health disparities among diverse populations. METHODS We conducted an ethnographic analysis of study documents including summaries of patient advisory committee meetings and interviews, reflective field notes written by study team members, and correspondence with our institutional review board (IRB). Through this analysis, we identified cross-cutting challenges for incorporating stakeholder feedback into development of our recruitment, risk assessment, and informed consent processes and materials. RESULTS Our analysis revealed three key challenges: (1) balancing precision and simplicity in the design of study materials, (2) providing clinical care within the research context, and (3) emphasizing potential study benefits versus risks and limitations. CONCLUSIONS While involving patient stakeholders in study design and materials development can increase inclusivity and responsiveness to patient needs, patient feedback may conflict with that of content area experts on the research team and IRBs who are tasked with overseeing the research. Our analysis highlights the need for further empirical research about ethical challenges when incorporating patient feedback into study design, and for dialogue with genomic researchers and IRB representatives about these issues.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - David Bui
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kelly Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | | | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Alyssa Koomas
- Alliance for a Healthier Generation, Portland, OR, USA
| | - Chelese L Ransom
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | - Paige Jackson
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sandra Soo-Jin Lee
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Goddard KA, Angelo FA, Ackerman SL, Berg JS, Biesecker BB, Danila MI, East KM, Hindorff LA, Horowitz CR, Hunter JE, Joseph G, Knight SJ, McGuire A, Muessig KR, Ou J, Outram S, Rahn EJ, Ramos MA, Rini C, Robinson JO, Smith HS, Waltz M, Lee SSJ. Lessons learned about harmonizing survey measures for the CSER consortium. J Clin Transl Sci 2020; 4:537-546. [PMID: 33948230 PMCID: PMC8057449 DOI: 10.1017/cts.2020.41] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/05/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium. METHODS A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing. RESULTS Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects. CONCLUSIONS In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
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Affiliation(s)
| | - Frank A.N. Angelo
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Sara L. Ackerman
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina, Chapel Hill, USA
| | | | - Maria I. Danila
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly M. East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | - Carol R. Horowitz
- Department of Medicine, General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Galen Joseph
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, USA
| | - Sara J. Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Amy McGuire
- Center for Medical Ethics and Health Policy at Baylor College of Medicine, Houston, TX, USA
| | - Kristin R. Muessig
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jeffrey Ou
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Simon Outram
- Program in Bioethics, University of California, San Francisco, USA
| | - Elizabeth J. Rahn
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle A. Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Jill O. Robinson
- Center for Medical Ethics and Health Policy at Baylor College of Medicine, Houston, TX, USA
| | - Hadley Stevens Smith
- Center for Medical Ethics and Health Policy at Baylor College of Medicine, Houston, TX, USA
| | - Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
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Lara-Otero K, Weil J, Guerra C, Cheng JKY, Youngblom J, Joseph G. Genetic Counselor and Healthcare Interpreter Perspectives on the Role of Interpreters in Cancer Genetic Counseling. Health Commun 2019; 34:1608-1618. [PMID: 30230379 DOI: 10.1080/10410236.2018.1514684] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cancer genetic counseling (CGC) combines psychosocial counseling and genetic education provided by genetic counselors to patients and families who have a history of cancer and are considering or have undergone genetic testing for hereditary cancer syndromes. The quantity and complexity of information provided can be challenging for any patient, but is even more so for those with limited English proficiency (LEP). This exploratory study investigated healthcare interpreters' and genetic counselors' perspectives on the role of interpreters in providing care to LEP patients during CGC. Through a survey of 18 interpreters and conventional content analysis of semi-structured interviews with 11 interpreters and 10 GCs at two California public hospitals, we found that: 1) interpreters viewed their role as patient advocate, cultural broker, and emotional support, not simply a conduit; 2) interpreters were challenged by remote interpretation, lack of genetic knowledge, and the emotional content of encounters; 3) interpreters and GCs held conflicting views of the value of counselors' limited Spanish knowledge; and 4) trust, the foundation of the interpreter-provider dyad, was often lacking. The challenges identified here may result in poor healthcare experiences and outcomes for LEP patients. As genomics becomes more widespread and more LEP patients encounter CGC, the role of healthcare interpreters in facilitating effective communication must be further defined in order to facilitate better working relationships between interpreters and genetic counselors, and optimal communication experiences for patients.
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Affiliation(s)
| | - Jon Weil
- Department of Biological Sciences, California State University, Stanislaus
| | - Claudia Guerra
- Department of Anthropology, History & Social Medicine, and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Janice Ka Yan Cheng
- Department of Anthropology, History & Social Medicine, and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Janey Youngblom
- Department of Biological Sciences, California State University, Stanislaus
| | - Galen Joseph
- Department of Anthropology, History & Social Medicine, and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
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44
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Joseph G, Marott JL, Sogaard P, Biering-Sorensen T, Johansen MB, Nielsen G, Jensen GB, Mogelvang R. P5727All-cause mortality and cardiovascular death according to blood pressure thresholds recommended by ACC/AHA. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The cut-off values for defining hypertension remains a matter of debate. Recently published guidelines from American College of Cardiology (ACC) /American Heart Association (AHA) defines hypertension at blood pressure (BP) of ≥130/80 in contrast to guidelines from European Society of Cardiology (ESC) defining hypertension as BP≥140/90. Adopting the ACC/AHA recommendation will lead to higher prevalence of hypertension in the general population and probably unnecessary medical treatment of persons at a low cardiovascular risk.
Aim
We aimed to explore whether the new definition of hypertension as defined from the ACC/AHA guidelines is associated with higher risk of mortality and cardiovascular death in the general population compared to their definition of normal BP.
Methods
A random sample of 20,000 Caucasian men and women aged 20–98 years were examined in a prospective cardiovascular population study. The population sample went through four examinations in 1976–78, 1981–83, 1991–94, and 2001–03. We defined the blood pressure levels according to the ACC/AHA guidelines: normal <130/80mmHg; Stage 1 hypertension: 130–139/80–89 mmHg; Stage II hypertension: ≥140/90 mmHg. The population was followed until April 2018 or until death. Cox regression with time varying covariates was performed. The analysis was adjusted for following confounders: age, sex, body mass index, level of daily physical activity, previous cardiovascular disease, diabetes, educational status, smoking status, cardiac medication, cholesterol, and calendar time. Univariable and multivariable analyses were performed. Primary outcome was all-cause mortality. Secondary outcome was cardiovascular death defined as death from acute myocardial infarction, stroke, or heart failure.
Results
All outcomes were assessed according to the ACC/AHA BP thresholds. Primary outcome: Considering normal BP (<130/80 mmHg) as reference, we did not find higher mortality in stage 1 hypertension (130–139/80–89 mmHg) in the multivariable analyses [HR 0.98 (95% CI: 0.93–1.05), p=0.67]. In stage 2 hypertension (≥140/90 mmHg), the mortality was significantly higher [HR 1.13 (95% 1.07–1.20), p<0.001]. We found the same pattern for the secondary outcome: The risk of cardiovascular death in stage 1 hypertension (130–139/80–89 mmHg) did not differ significantly from normal BP (<130/80 mmHg) [HR 1.08 (95% CI: 0.95–1.22), p=0.25]. In stage 2 hypertension (≥140/90 mmHg), cardiovascular death was significantly higher [HR 1.50 (95% CI 1.35–1.66), p<0.001].
Mortality in BP thresholds by ACC/AHA
Conclusion
Hypertension as defined by the ACC/AHA guidelines is not associated with higher all-cause mortality or cardiovascular death in the general population. Applying ACC/AHA guidelines might lead to unnecessary medical treatment of a low-risk population. In contrast, the ESC-definition of hypertension refers to a high-risk population in terms of all-cause mortality and cardiovascular death.
Acknowledgement/Funding
Danish Heart Foundation
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Affiliation(s)
- G Joseph
- Aalborg University, Aalborg, Denmark
| | - J L Marott
- Frederiksberg University Hospital, The Copenhagen City Heart Study, Frederiksberg, Denmark
| | - P Sogaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - M B Johansen
- Aalborg University Hospital, Unit of Clinical Biostatistics, Aalborg, Denmark
| | - G Nielsen
- Vendsyssel Hospital, Department of Cardiology, Hjorring, Denmark
| | - G B Jensen
- Frederiksberg University Hospital, The Copenhagen City Heart Study, Frederiksberg, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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45
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Nickell A, Stewart SL, Burke NJ, Guerra C, Cohen E, Lawlor C, Colen S, Cheng J, Joseph G. Engaging limited English proficient and ethnically diverse low-income women in health research: A randomized trial of a patient navigator intervention. Patient Educ Couns 2019; 102:1313-1323. [PMID: 30772115 PMCID: PMC8846431 DOI: 10.1016/j.pec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Evaluate a community-based navigator intervention to increase breast cancer patients' and survivors' access to information about health research participation opportunities. METHODS In the context of a Community Based Participatory Research collaboration, we conducted a prospective randomized controlled trial of the Health Research Engagement Intervention with pre- and post-intervention surveys (n = 133). The primary outcome was health research information-seeking behavior. Secondary outcomes were health research knowledge, willingness to participate in health research, and health empowerment. Qualitative interviews (n = 11) elucidated participant perspectives on the intervention. RESULTS There was no statistically significant difference between intervention and control groups' information-seeking behavior. Knowledge that not all health research studies are about drugs or treatments increased significantly from pre- to post-test among intervention group participants (32% to 48%, p = 0.012), but not in the control group (43% to 30%, p = 0.059); the difference between arms was statistically significant (p = 0.0012). Although survey responses indicated willingness to participate, qualitative interviews identified competing priorities that limited participants' motivation to seek enrollment information. CONCLUSIONS AND PRACTICE IMPLICATIONS Community-based navigators are a trusted, and therefore promising link between health research and low-income underserved communities. However, systemic barriers in health research infrastructures need to be addressed to include low income, LEP and immigrant populations.
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Affiliation(s)
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, USA
| | - Nancy J Burke
- Public Health University of California, Merced, USA; Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Claudia Guerra
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Elly Cohen
- BreastCancerTrials.org, San Francisco, USA
| | | | | | - Janice Cheng
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA.
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46
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Ghosh S, Joseph G, Korza G, He L, Yuan J, Dong W, Setlow B, Li Y, Savage P, Setlow P. Effects of the microbicide ceragenin CSA‐13 on and properties ofBacillus subtilisspores prepared on two very different media. J Appl Microbiol 2019; 127:109-120. [DOI: 10.1111/jam.14300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 03/23/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Affiliation(s)
- S. Ghosh
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
- Department of Science and Mathematics Capital Community College Hartford CT USA
| | - G. Joseph
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
| | - G. Korza
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
| | - L. He
- Department of Physics East Carolina University Greenville NC USA
- School of Electronic Engineering Dongguan University of Technology Dongguan People’s Republic of China
| | - J.‐H. Yuan
- Department of Physics East Carolina University Greenville NC USA
| | - W. Dong
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
- School of Resource and Environmental Engineering Jiangxi University of Science and Technology Ganzhou China
| | - B. Setlow
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
| | - Y.‐Q. Li
- Department of Physics East Carolina University Greenville NC USA
- School of Electronic Engineering Dongguan University of Technology Dongguan People’s Republic of China
| | - P.B. Savage
- Department of Chemistry and Biochemistry Brigham Young University Provo UT USA
| | - P. Setlow
- Department of Molecular Biology and Biophysics UConn Health Farmington CT USA
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47
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Van Blarigan EL, Chan H, Van Loon K, Kenfield SA, Chan JM, Mitchell E, Zhang L, Paciorek A, Joseph G, Laffan A, Atreya CE, Fukuoka Y, Miaskowski C, Meyerhardt JA, Venook AP. Self-monitoring and reminder text messages to increase physical activity in colorectal cancer survivors (Smart Pace): a pilot randomized controlled trial. BMC Cancer 2019; 19:218. [PMID: 30866859 PMCID: PMC6417122 DOI: 10.1186/s12885-019-5427-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background Over 1.3 million people live with colorectal cancer in the United States. Physical activity is associated with lower risk of colorectal cancer recurrence and mortality. Interventions are needed to increase physical activity in colorectal cancer survivors. Methods We conducted a 2-arm non-blinded pilot randomized controlled trial at the University of California, San Francisco among 42 individuals who had completed curative-intent treatment for colorectal cancer to determine the feasibility and acceptability of a 12-week (84 days) physical activity intervention using a Fitbit Flex™ and daily text messages. Participants were randomized 1:1 to receive the intervention with print educational materials or print educational materials alone. We explored the impact of the intervention versus usual care on physical activity using ActiGraph GT3X+ accelerometers pre−/post-intervention. Results We screened 406 individuals and randomized 42 to intervention (n = 21) or control (n = 21) groups. During the 12-week study, the intervention arm wore their Fitbits a median of 74 days [88% of days in study period, interquartile range: 23–83 days] and responded to a median of 34 (out of 46) text messages that asked for a reply (interquartile range: 13–38 text messages). Among the 16 intervention participants who completed the feedback survey, the majority (88%) reported that the intervention motivated them to exercise and that they were satisfied with their experience. No statistically significant difference in change in moderate-to-vigorous physical activity was found from baseline to 12 weeks between arms. Conclusion A 12-week physical activity intervention with a Fitbit and text messages was feasible and acceptable among colorectal cancer patients after curative treatment. Larger studies are needed to determine whether the intervention increases physical activity. Trial registration Clinicaltrials.gov Identifier NCT02966054. Registered 17 November 2016, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12885-019-5427-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA. .,Department of Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Hilary Chan
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Emily Mitchell
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA.,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Alan Paciorek
- Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Galen Joseph
- Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Angela Laffan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Chloe E Atreya
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.,Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Alan P Venook
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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48
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Joseph G, Lee R, Pasick RJ, Guerra C, Schillinger D, Rubin S. Effective communication in the era of precision medicine: A pilot intervention with low health literacy patients to improve genetic counseling communication. Eur J Med Genet 2018; 62:357-367. [PMID: 30553023 DOI: 10.1016/j.ejmg.2018.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 01/19/2023]
Abstract
Effective communication, where all parties share a common understanding, is necessary to realize the promise of Genomic Medicine. It is especially salient given the imperative to increase the participation of diverse populations in genomics research and to expand the reach of clinical genomics. We have previously shown that cancer genetic counseling is suboptimal for patients with limited health literacy. To address this finding, we implemented a pilot study to improve verbal communication between genetic counselors and their patients of limited health literacy that consisted of: i) curriculum development and delivery of a Genetic Counselors (GC) communication workshop; ii) two-month post-workshop interviews with GC participants (n = 9); iii) observations/audio recordings of counseling sessions involving 24 patients and two GC workshop participants; iv) post-counseling interviews with patients (n = 9). The 4.5-h workshop presented evidenced-based principles and strategies for effective communication with limited health literacy patients (e.g. use of plain language and teach-back), and offered specific techniques and exercises to practice adoption of such practices in the genetic counseling context. GCs expressed appreciation for the opportunity to refine their skills; however, they reported that some strategies were challenging given their professional training and communication habits. For example, GCs were concerned that use of plain language could undermine efforts to obtain informed consent and provide scientifically accurate information. Observations and patient interviews after the workshop revealed that GCs were able to employ the communication strategies with positive effects, with patients indicating sufficient understanding of the genetic test and its implications as well as satisfaction with the counselors' communication. While derived from research on communication with those of limited health literacy, the communication approaches taught in the GC workshop could benefit most patients, given the high rates of low health literacy in many countries, and the many factors beyond health literacy that can contribute to reduced comprehension in health care environments.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States.
| | - Robin Lee
- Cancer Genetics & Prevention Program, University of California, San Francisco, United States
| | - Rena J Pasick
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States; Department of General Internal Medicine, University of California, San Francisco, United States
| | - Claudia Guerra
- Department of General Internal Medicine, University of California, San Francisco, United States
| | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, United States
| | - Sara Rubin
- Department of Social & Behavioral Sciences, University of California, San Francisco, United States
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Stafford R, Mweteni W, Joseph G. PO645 Use of Rapid Point of Care Testing For Diagnosis of Group A Strep Throat In Western Tanzania. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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50
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Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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