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Scherr CL, Kalke K, Ramesh S, Fakhari H, Dellefave-Castillo LM, Smith ME, Kalny C, McNally EM, Rasmussen-Torvik LJ. Integrating clinical genetics in cardiology: Current practices and recommendations for education. Genet Med 2022; 24:1054-1061. [PMID: 35339388 PMCID: PMC9991006 DOI: 10.1016/j.gim.2022.02.003] [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: 11/10/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Recent advances in genetics can facilitate the identification of at-risk individuals and diagnosis of cardiovascular disorders. As a nascent field, more research is needed to optimize the clinical practice of cardiovascular genetics, including the assessment of educational needs to promote appropriate use of genetic testing. METHODS Qualitative interviews conducted with cardiovascular specialists (N = 43) were audiotaped. Thematic analysis was conducted on professional transcripts. RESULTS Participants recognized the value of genetics in identifying and diagnosing at-risk individuals. However, organizational systems, cost, and feeling of unpreparedness were identified as barriers. Participants felt that the rapid pace of genetic science resulted in further challenges to maintaining an adequate knowledge base and highlighted genetics experts' importance. Even when a genetics expert was available, participants wanted to know more about which patients benefit most from genetic testing and expressed a desire to better understand management recommendations associated with a positive test result. CONCLUSION Participants recognized the benefit but felt underprepared to provide recommendations for genetic testing and, in some cases, lacked organizational resources to refer patients to a genetics expert. Additional training in genetics for cardiology practitioners and ensuring availability of a genetics expert can improve the use of genetics in cardiology settings.
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Affiliation(s)
- Courtney L Scherr
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL.
| | - Kerstin Kalke
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Sanjana Ramesh
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Hoda Fakhari
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Lisa M Dellefave-Castillo
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Callie Kalny
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura J Rasmussen-Torvik
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
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Lopez Santibanez Jacome L, Dellefave-Castillo LM, Wicklund CA, Scherr CL, Duquette D, Webster G, Smith ME, Kalke K, Gordon AS, De Berg K, McNally EM, Rasmussen-Torvik LJ. Practitioners' Confidence and Desires for Education in Cardiovascular and Sudden Cardiac Death Genetics. J Am Heart Assoc 2022; 11:e023763. [PMID: 35322684 PMCID: PMC9075463 DOI: 10.1161/jaha.121.023763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Educating cardiologists and health care professionals about cardiovascular genetics and genetic testing is essential to improving diagnosis and management of patients with inherited cardiomyopathies and arrhythmias and those at higher risk for sudden cardiac death. The aim of this study was to understand cardiology and electrophysiology practitioners’ current practices, confidence, and knowledge surrounding genetic testing in cardiology and desired topics for an educational program. Methods and Results A one‐time survey was administered through purposive email solicitation to 131 cardiology practitioners in the United States. Of these, 107 self‐identified as nongenetic practitioners. Over three quarters of nongenetic practitioners reported that they refer patients to genetic providers to discuss cardiovascular genetic tests (n=82; 76.6%). More than half of nongenetic practitioners reported that they were not confident about the types of cardiovascular genetic testing available (n=60; 56%) and/or in ordering appropriate cardiovascular genetic tests (n=66; 62%). In addition, 45% (n=22) of nongenetic practitioners did not feel confident making cardiology treatment recommendations based on genetic test results. Among all providers, the most desired topics for an educational program were risk assessment (94%) and management of inherited cardiac conditions based on guidelines (91%). Conclusions This study emphasizes the importance of access to genetics services in the cardiology field and the need for addressing the identified deficit in confidence and knowledge about cardiogenetics and genetic testing among nongenetic providers. Additional research is needed, including more practitioners from underserved areas.
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Affiliation(s)
| | | | - Catherine A Wicklund
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Courtney L Scherr
- Department of Communication Studies Northwestern University Chicago IL
| | - Debra Duquette
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Gregory Webster
- Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Maureen E Smith
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Kerstin Kalke
- Department of Communication Studies Northwestern University Chicago IL
| | - Adam S Gordon
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Elizabeth M McNally
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
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Kalke K, Studd H, Scherr CL. The communication of uncertainty in health: A scoping review. Patient Educ Couns 2021; 104:1945-1961. [PMID: 33593644 DOI: 10.1016/j.pec.2021.01.034] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To conduct a scoping review of existing studies that examine communication strategies that address uncertainty in health and categorize them using the taxonomy of uncertainty. METHODS Relevant articles retrieved from ten databases were categorized according to the dimensions of the taxonomy of uncertainty, and study characteristics were extracted from each article. RESULTS All articles (n = 63) explored uncertainty in the context of probabilistic risk and related to scientific issues (n = 63; 100%). The majority focused on complexity (n = 24; 38.1%) and uncertainty experienced by patients (n = 52; 82.5%). Most utilized quantitative methods (n = 46; 73.0%), hypothetical scenarios (n = 49; 77.8%), and focused on cancer (n = 20; 31.7%). Theory guided messages and study design in fewer than half (n = 27; 42.9%). CONCLUSIONS Heterogeneity in terminology used to refer to different types of uncertainties preclude a unified research agenda on uncertainty communication. Research predominately focuses on probability as the source of uncertainty, uncertainties related to scientific issues, and uncertainty experienced by patients. PRACTICE IMPLICATIONS Additional efforts are needed to understand providers' experience of uncertainty, and to identify strategies to address ambiguity. Future studies should use consistent terminology to allow for coherence and advancement of uncertainty communication scholarship. Continued efforts to refine the existing taxonomy should be undertaken.
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Affiliation(s)
- Kerstin Kalke
- Department of Communication Studies, Northwestern University, Chicago, IL, USA.
| | - Hannah Studd
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - Courtney L Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
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Scherr CL, Ramesh S, Getachew-Smith H, Kalke K, Ramsey K, Fischhoff B, Vadaparampil ST. How patients deal with an ambiguous medical test: Decision-making after genetic testing. Patient Educ Couns 2021; 104:953-959. [PMID: 33214013 DOI: 10.1016/j.pec.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/31/2020] [Revised: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We know little about how patients make decisions when they receive a variant of uncertain significance result (VUS) from genetic testing. The purpose of this study was to elucidate a model of patient-informed decision-making after receiving a VUS result. METHODS Using an adapted Mental Models Approach, we conducted semi-structured interviews with women who received a VUS result from genetic testing for hereditary breast cancer (N = 20) to explore factors they believed were relevant to their decision-making. Two coders used a coding scheme informed by experts in hereditary breast cancer to conduct analysis. Inter-coder reliability was α = .86. RESULTS Three overarching decision themes emerged from the interviews: managing ambiguity, medical risk management, and sharing results with others. While participants noted some difficulty understanding their result, genetic counselors' interpretations, psychosocial factors (e.g., risk perceptions), and competing extrinsic demands influenced their decisions. CONCLUSION Complex influences affect patient decision-making after a VUS result from genetic testing and may encourage health protective behavior. PRACTICE IMPLICATIONS Even patients who understand their test result could use support managing the ambiguity of their test result and sharing it with others.
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Affiliation(s)
- Courtney L Scherr
- Department of Communication, Northwestern University, Chicago, IL, USA.
| | - Sanjana Ramesh
- Department of Communication, Northwestern University, Chicago, IL, USA
| | | | - Kerstin Kalke
- Department of Communication, Northwestern University, Chicago, IL, USA
| | - Kyra Ramsey
- Department of Communication, Northwestern University, Chicago, IL, USA
| | - Baruch Fischhoff
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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Kalke K, Ginossar T, Bentley JM, Carver H, Shah SFA, Kinney AY. Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis. JMIR Mhealth Uhealth 2020; 8:e14082. [PMID: 32012084 PMCID: PMC7007595 DOI: 10.2196/14082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/20/2019] [Revised: 07/22/2019] [Accepted: 08/31/2019] [Indexed: 12/29/2022] Open
Abstract
Background Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum.
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Affiliation(s)
- Kerstin Kalke
- Department of Communication Studies, Northwestern University, Evanston, IL, United States
| | - Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, United States
| | - Joshua M Bentley
- Department of Strategic Communication, Texas Christian University, Fort Worth, TX, United States
| | - Hannah Carver
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Sayyed Fawad Ali Shah
- Department of Communication, Jacksonville State University, Jacksonville, AL, United States
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, NJ, United States.,Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
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