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Ballard LM, Doheny S, Dimond R, Lucassen AM, Clarke AJ. Predictive genetic testing for Huntington's disease: Exploring participant experiences of uncertainty and ambivalence between clinic appointments. J Genet Couns 2024. [PMID: 38741209 DOI: 10.1002/jgc4.1911] [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: 07/01/2023] [Revised: 04/25/2024] [Accepted: 02/05/2024] [Indexed: 05/16/2024]
Abstract
Ambivalence and uncertainty are key themes throughout the psychology of healthcare literature. This is especially so for individuals at risk of Huntington's disease (HD) deliberating the decision to undergo genetic testing because there is currently no treatment that modifies disease progression. A better understanding of the experience of making a decision about genetic prediction will help practitioners support and guide individuals through this process. Our aim was to capture participants' experiences of uncertainty and ambivalence in between their genetic counseling appointments. We explored these issues through the experiences of nine participants who were referred for predictive HD testing at four regional genetics services in England and Wales. Data consisted of recordings of clinic consultations, diaries, and an in-depth interview conducted at the end of the testing process. Data were analyzed thematically. Four themes were identified representing four possible futures, each future dependent on the decision to undergo testing and the result of that test. Our results showed that participants, as well as attending more to a future that represents their current situation of not having undergone predictive testing, also attended more to a distant future where a positive predictive result is received and symptoms have started. Participants attended less to the two futures that were more immediate once testing was undertaken (a future where a positive result is received and symptoms have not started and a future where a negative result is received). The use of diaries gave us a unique insight into these participants' experiences of ambivalence and uncertainty, psychological distress, and the emotional burden experienced. These findings help inform discussions within the clinic appointment as well as encourage researchers to consider diary use as a method of exploring what happens for individuals outside of clinical encounters.
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Affiliation(s)
- L M Ballard
- Clinical Ethics, Law & Society (CELS), Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Aldermoor Close, Southampton, UK
| | - S Doheny
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Dimond
- School of Social Science, Cardiff University, Cardiff, Wales, UK
| | - A M Lucassen
- Clinical Ethics, Law & Society (CELS), Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Aldermoor Close, Southampton, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - A J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Samuel G, Ballard LM, Carley H, Lucassen AM. Ethical preparedness in health research and care: the role of behavioural approaches. BMC Med Ethics 2022; 23:115. [PMCID: PMC9672545 DOI: 10.1186/s12910-022-00853-1] [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] [Received: 05/09/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Public health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability (ability), opportunity, and motivation (willingness) to work in an ethically prepared way.
Methods
We use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.
Results
Our analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge (or principles and frameworks), a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.
Conclusions
To understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared.
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Moore PJ, Rao JR, Nelson D, McCollum G, Ballard LM, Millar BC, Nakanishi S, Tasaki E, Nakajima T, Matsuda M, Goldsmith CE, Coulter WA, Loughrey A, Rooney RJ, O'Sullivan JT, Moore JE. Examination of the antibacterial properties of sphagnum moss (Sphagnum spp.) and its significance with turf burning in Ireland. Br J Biomed Sci 2019. [DOI: 10.1080/09674845.2012.12069149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- P. J. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
- Ballymena Academy, Ballymena
| | - J. R. Rao
- Applied Plant Science Division, Agri-Food & Biosciences Institute (AFBI), Belfast
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine
| | - D. Nelson
- Applied Plant Science Division, Agri-Food & Biosciences Institute (AFBI), Belfast
| | - G. McCollum
- Applied Plant Science Division, Agri-Food & Biosciences Institute (AFBI), Belfast
| | - L. M. Ballard
- Ulster Folk and Transport Museum, Cultra, Holywood, Co. Down, Northern Ireland
| | - B. C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
| | - S. Nakanishi
- Laboratory for Molecular Biology, School of Environmental Health Sciences, Azabu University, Sagamihara, Kanagawa 229, Japan
| | - E. Tasaki
- Laboratory for Molecular Biology, School of Environmental Health Sciences, Azabu University, Sagamihara, Kanagawa 229, Japan
| | - T. Nakajima
- Laboratory for Molecular Biology, School of Environmental Health Sciences, Azabu University, Sagamihara, Kanagawa 229, Japan
| | - M. Matsuda
- Laboratory for Molecular Biology, School of Environmental Health Sciences, Azabu University, Sagamihara, Kanagawa 229, Japan
| | - C. E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
| | - W. A. Coulter
- School of Dentistry, The Queen's University of Belfast, Northern Ireland
| | - A. Loughrey
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
| | - R. J. Rooney
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
| | | | - J. E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine
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Moore RJ, Rao JR, Nelson D, McCollum G, Ballard LM, Millar BC, Nakanishi S, Tasaki E, Nakajima T, Matsuda M, Goldsmith CE, Coulter WA, Loughrey A, Rooney RJ, O'Sullivan JT, Moore JE. Examination of the antibacterial properties of sphagnum moss (Sphagnum spp.) and its significance with turf burning in Ireland. Br J Biomed Sci 2012; 69:178-180. [PMID: 23304795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- R J Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Ireland.
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