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Clark EB, Bonini KE, Pugh Yi RH, Kuhn E, Klemp JR, Rose D, Owens KN, Welcsh PL, Conaty J, Duquette D, Friedman SJ, Dean M. Experiences of genetic counselors in referring young and metastatic breast cancer patients to support services: A needs assessment. Patient Educ Couns 2023; 116:107946. [PMID: 37625308 DOI: 10.1016/j.pec.2023.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Conduct a needs assessment to explore the experiences, barriers, and needs of genetic counselors (GCs), who counsel and refer young and metastatic breast cancer (BC) patients to support services, in order to develop resources to address any noticeable gaps. METHODS GCs providing care to BC patients were eligible to complete the survey. Support services were defined as resources to address patient-centered healthcare, emotional, and quality-of-life needs. RESULTS Most participants (n = 117) reported familiarity with cancer prevention services (93%); fewer were familiar with services secondary to a BC diagnosis (e.g., fatigue=16% and sexual health=24%). The volume of GCs indicating familiarity with support services increased significantly as work experience increased for seven services. Many (>50%) never referred patients to most (9/12) support services, excluding cancer prevention, mental health, and financial issues. Open-ended responses highlighted that GCs considered referrals to be outside their scope of practice or that healthcare systems prevent GCs from making referrals. CONCLUSION GCs may benefit from curated resources and materials, especially for support services secondary to a BC diagnosis, to better support their patients. PRACTICAL IMPLICATIONS Collaboration of GCs with other health professionals through integrative care programs may decrease burdens to accessing support services.
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Affiliation(s)
| | - Katherine E Bonini
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Jennifer R Klemp
- The University of Kansas Cancer Center, Westwood, USA; Division of Clinical Oncology, Caris Life Sciences, Irving, USA
| | - Diane Rose
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Kelly N Owens
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Piri L Welcsh
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Jessica Conaty
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, USA; Health Outcomes & Behavior Program, Moffitt Cancer Center. Tampa, USA.
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2
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Hayes T, Cunningham M, Trepanier A. Investigating factors that influence genetic counselors' decisions to refer patients to mental health providers. J Genet Couns 2022; 31:1113-1124. [PMID: 35460529 DOI: 10.1002/jgc4.1582] [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: 08/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022]
Abstract
Genetic counselors (GC) serve patients who are often in distress at the time of their consultation. GC competency includes providing short-term, client-centered counseling, while using community resources, such as mental health providers (MHPs), for psychosocial support. The purpose of this study was to assess the mental health referral practices of GCs; specifically, the rate of referrals, factors influencing a GC's decision to refer, and barriers to referrals. GCs working in direct patient care for at least one year were recruited to take a novel 27 question survey created based on the results of a previous qualitative study. A link to the web-based survey was distributed through the National Society of Genetic Counselors Student Research Program and American Board of Genetic Counselors by email. A total of 144 individuals opened the survey for an estimated response rate of 3%. A majority of respondents (54.3%) reported they assess a patient's need for a mental health referral at least half of the time. The mean number of referrals made in the past 12 months was 5.13. After post-hoc analyses, there were no differences in referral rates between specialties. Common referral indications included patient history of mental illness, distress about having a genetic condition, and limited social support. Common barriers to referral were financial or insurance related, patient receptiveness, and the patient not perceiving a benefit. GCs felt that providing psychosocial support is within their scope of practice, but that MHPs are better equipped to manage long-term needs and those related to a mental health condition. This study provides insight into how GCs decide when they can manage patient distress, circumstances that prompt a referral to MHPs, and barriers. Recognizing common referral indications and barriers may lead to better strategies for connecting patients with such services.
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Affiliation(s)
- Taylor Hayes
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA.,Henry Ford Health System, Detroit, Michigan, USA
| | - Mitchell Cunningham
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA.,Mercy Clinic - Genetics, Mercy Hospital St. Louis, St. Louis, Missouri, USA
| | - Angela Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
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3
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Carmichael N, Redlinger-Grosse K, Birnbaum S. Supporting a sense of inclusion and belonging for genetic counseling students who identify as racial or ethnic minorities. J Genet Couns 2021; 30:813-827. [PMID: 33550646 DOI: 10.1002/jgc4.1381] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 11/07/2022]
Abstract
Racial and ethnic minority graduate students in a variety of academic and professional disciplines have been reported to experience microaggressions and feelings of isolation during the course of their training. The purpose of this constructivist grounded theory study was to characterize the training experiences of genetic counseling students who identify as racial or ethnic minorities. The goal of enhancing racial and ethnic diversity has been discussed for decades within the genetic counseling profession, but the actual training experience of underrepresented minorities has yet to be fully explored. We conducted 13 videoconference focus groups with 32 recent graduates of genetic counseling training programs who identify as racial or ethnic minorities. This paper presents results from three of the thematic categories identified in that larger study: Participants' interactions with classmates, Sense of belonging in the GC profession, and Available or desired supports. Participants reported experiencing negative interactions within their training program, during supervised clinical rotations, and at professional events; negative interactions included comments suggesting they did not belong in the United States, being confused with another non-white classmate, and intrusive questions or assumptions about their family, culture, or religion that were not similarly directed at white classmates. Trainees who were Muslim or Black/African American reported feeling particularly isolated by these incidents. Participants reported that they sought support from a variety of sources following negative experiences. Non-minority program faculty were perceived as able to offer listening or action but not understanding or guidance, which were perceived as more likely to be available from individuals who identify as racial or ethnic minorities. Results of this exploratory study suggest the need for training programs to ensure that appropriate supports are available to minority students, including diverse faculty and staff and non-program resources.
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Affiliation(s)
- Nikkola Carmichael
- Graduate School of Arts and Sciences, Brandeis University, Waltham, MA, USA.,Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Shira Birnbaum
- Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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4
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Medendorp NM, Hillen MA, van Maarschalkerweerd PEA, Aalfs CM, Ausems MGEM, Verhoef S, van der Kolk LE, Berger LPV, Wevers MR, Wagner A, Caanen BAH, Stiggelbout AM, Smets EMA. 'We don't know for sure': discussion of uncertainty concerning multigene panel testing during initial cancer genetic consultations. Fam Cancer 2019; 19:65-76. [PMID: 31773425 PMCID: PMC7026220 DOI: 10.1007/s10689-019-00154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/16/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
Pre-test counseling about multigene panel testing involves many uncertainties. Ideally, counselees are informed about uncertainties in a way that enables them to make an informed decision about panel testing. It is presently unknown whether and how uncertainty is discussed during initial cancer genetic counseling. We therefore investigated whether and how counselors discuss and address uncertainty, and the extent of shared decision-making (SDM), and explored associations between counselors’ communication and their characteristics in consultations on panel testing for cancer. For this purpose, consultations of counselors discussing a multigene panel with a simulated patient were videotaped. Simulated patients represented a counselee who had had multiple cancer types, according to a script. Before and afterwards, counselors completed a survey. Counselors’ uncertainty expressions, initiating and the framing of expressions, and their verbal responses to scripted uncertainties of the simulated patient were coded by two researchers independently. Coding was done according to a pre-developed coding scheme using The Observer XT software for observational analysis. Additionally, the degree of SDM was assessed by two observers. Correlation and regression analyses were performed to assess associations of communicated uncertainties, responses and the extent of SDM, with counselors’ background characteristics. In total, twenty-nine counselors, including clinical geneticists, genetic counselors, physician assistants-in-training, residents and interns, participated of whom working experience varied between 0 and 25 years. Counselors expressed uncertainties mainly regarding scientific topics (94%) and on their own initiative (95%). Most expressions were framed directly (77%), e.g. We don’t know, and were emotionally neutral (59%; without a positive/negative value). Counselors mainly responded to uncertainties of the simulated patient by explicitly referring to the uncertainty (69%), without providing space for further disclosure (66%). More experienced counselors provided less space to further disclose uncertainty (p < 0.02), and clinical geneticists scored lower on SDM compared with other types of counselors (p < 0.03). Our findings that counselors mainly communicate scientific uncertainties and use space-reducing responses imply that the way counselors address counselees’ personal uncertainties and concerns during initial cancer genetic counseling is suboptimal.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lieke P V Berger
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke R Wevers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara A H Caanen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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5
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Heinlen C, Hovick SR, Brock GN, Klamer BG, Toland AE, Senter L. Exploring genetic counselors' perceptions of usefulness and intentions to use refined risk models in clinical care based on the Technology Acceptance Model (TAM). J Genet Couns 2019; 28:664-672. [PMID: 30843639 PMCID: PMC6548677 DOI: 10.1002/jgc4.1079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/26/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
Abstract
Pathogenic germline mutations in the BRCA1 or BRCA2 genes are associated with an elevated lifetime risk for breast (50%-85% risk) and ovarian cancer (20%-40% risk). Genome-wide association studies have identified over 100 genetic variants associated with modified breast and/or ovarian cancer risk in BRCA1 and BRCA2 carriers. Risk models generated based on these variants have shown that these genetic modifiers strongly influence absolute risk of developing breast or ovarian cancer in BRCA mutation carriers. There is a lack of understanding, however, about the clinical applicability and utility of these risk models. To investigate this gap, we collected survey data from 274 cancer genetic counselors (GCs) through the National Society of Genetic Counselors Cancer Special Interest Group. Questions assessed perceptions of usefulness and intentions of genetic counselors to use these refined risk models in clinical care based on the Technology Acceptance Model (TAM). We found that GCs' reactions to the estimates were largely positive, though they thought the possibility of changing management based on results was unlikely. Additionally, we found that more experienced GCs were more likely to consider refined risk estimates in clinic. Support also was provided for core predictions within the TAM, whereby the perceived usefulness (indirect effect est. = 0.08, 95% CI: [0.04, 0.13]) and perceived ease of use (indirect effect est. = 0.078, 95% CI: [0.04, 0.13]) of refined risk estimates were indirectly associated with intentions to use via attitudes.
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Affiliation(s)
- Christopher Heinlen
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- Genetic Counseling Program, Department of Genetics, OhioHealth, Columbus, Ohio
| | - Shelly R Hovick
- School of Communication, The Ohio State University, Columbus, Ohio
| | - Guy N Brock
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brett G Klamer
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Amanda Ewart Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Cancer Biology and Genetics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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6
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Collet G, Parodi N, Cassinari K, Neviere Z, Cohen F, Gasnier C, Brahimi A, Lecoquierre F, Thery JC, Tennevet I, Lacaze E, Berthet P, Frebourg T. Cost-effectiveness evaluation of pre-counseling telephone interviews before face-to-face genetic counseling in cancer genetics. Fam Cancer 2019; 17:451-457. [PMID: 29080081 DOI: 10.1007/s10689-017-0049-z] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the main challenges in cancer genetics is responding to the exponential demand for genetic counseling, especially in patients with breast and/or ovarian cancer. To address this demand, we have set up a new procedure, based on pre-genetic counseling telephone interviews (PTI) followed by routing of patients: D1, a PTI is scheduled within 14 days; D7-D14, genetic counselors perform a 20 min PTI in order to establish a pre-genetic counseling file, by collecting personal and family medical history via a structured questionnaire and; D10-17, routing: pre-genetic counseling appointment files are analyzed by a cancer geneticist with 3 possible conclusions: (a) priority face-to-face genetic counseling (FTFGC) appointment with a cancer geneticist, if the genetic test results have an immediate therapeutic impact; (b) non-priority FTFGC with a genetic counselor, or (c) no FTFGC required or substitution by a more appropriate index case. In the context of breast and/or ovarian cancer, 1012 patients received PTIs, 39.1% of which did not lead to FTFGC. The mean delay for non-priority FTFGC was maintained at 18 weeks and priority FTFGC appointments were guaranteed within 8 weeks. The required resources for 1012 patients was estimated at 0.12 FTE secretaries, 0.62 FTE genetic counselors and 0.08 FTE cancer geneticists and the procedure was shown to be cost-effective. This new procedure allows the suppression of up to 1/3 of appointments, guarantees priority for appointments with therapeutic impact and optimizes the interaction and breakdown of tasks between genetic counselors and cancer geneticists.
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Affiliation(s)
- Gaëlle Collet
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Nathalie Parodi
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Kevin Cassinari
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Zoe Neviere
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Fanny Cohen
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Céline Gasnier
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Afane Brahimi
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - François Lecoquierre
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Jean-Christophe Thery
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Oncology, Comprehensive Cancer Centre Henri Becquerel, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Isabelle Tennevet
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
- Department of Oncology, Comprehensive Cancer Centre Henri Becquerel, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Elodie Lacaze
- Department of Genetics, Le Havre General Hospital, Normandy Centre for Genomic and Personalized Medicine, 76600, Le Havre, France
| | - Pascaline Berthet
- Department of Genetics, Comprehensive Cancer Centre François Baclesse, Normandy Centre for Genomic and Personalized Medicine, 14000, Caen, France
| | - Thierry Frebourg
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France.
- Department of Genetics, Rouen University Hospital, 22 boulevard Gambetta, 76183, Rouen Cedex 1, France.
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Agatisa PK, Mercer MB, Coleridge M, Farrell RM. Genetic Counselors' Perspectives About Cell-Free DNA: Experiences, Challenges, and Expectations for Obstetricians. J Genet Couns 2018; 27:1374-1385. [PMID: 29951719 DOI: 10.1007/s10897-018-0268-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 11/25/2017] [Accepted: 06/04/2018] [Indexed: 12/18/2022]
Abstract
The expansion of cell-free fetal DNA (cfDNA) screening for a larger and diverse set of genetic variants, in addition for use among the low-risk obstetric population, presents important clinical challenges for all healthcare providers involved in the delivery of prenatal care. It is unclear how to leverage the different members of the healthcare team to respond to these challenges. We conducted interviews with 25 prenatal genetic counselors to understand their experience with the continued expansion of cfDNA screening. Participants supported the use of cfDNA screening for the common autosomal aneuploidies, but noted some reservations for its use to identify fetal sex and microdeletions. Participants reported several barriers to ensuring that patients have the information and support to make informed decisions about using cfDNA to screen for these different conditions. This was seen as a dual-sided problem, and necessitated additional education interventions that addressed patients seeking cfDNA screening, and obstetricians who introduce the concepts of genetic risk and cfDNA to patients. In addition, participants noted that they have a professional responsibility to educate obstetricians about cfDNA so they can be prepared to be gatekeepers of counseling and education about this screening option for use among the general obstetric population.
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Affiliation(s)
- Patricia K Agatisa
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | - Mary Beth Mercer
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ruth M Farrell
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA.
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, USA.
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8
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Leppert K, Bisordi K, Nieto J, Maloney K, Guan Y, Dixon S, Egense A. Genetic Counselors' Experience with and Opinions on the Management of Newborn Screening Incidental Carrier Findings. J Genet Couns 2018; 27:1328-40. [PMID: 29687313 DOI: 10.1007/s10897-018-0258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 04/04/2018] [Indexed: 11/25/2022]
Abstract
Newborn screening (NBS) is a public health program whose aim is to identify infants who will be clinically affected with a serious metabolic, genetic, or endocrine disorder; however, the technology utilized by many NBS programs also detects infants who are heterozygous carriers for autosomal recessive conditions. Discussion surrounding disclosure of these incidental carrier findings remains controversial. The purpose of this study was to assess genetic counselors’ attitudes about disclosure of carrier status results generated by NBS and to gather data on their experiences with incidental carrier findings. An electronic survey was distributed to genetic counselors of all specialties via the NSGC listserv, and a total of 235 survey responses were analyzed. Quantitative data were analyzed using IBM SPSS v24, and qualitative data were manually analyzed for thematic analysis. Results show that the counselor participants were overall in favor of routine disclosure. Those with experience in NBS were much more likely to strongly agree with one or more reasons for disclosure (p < 0.001), whereas those with five or fewer years of experience were more likely to strongly agree with one or more reasons for non-disclosure (p = 0.031). Qualitative analysis identified key motivating factors for disclosure, including helping parents to understand a positive screen, parents may otherwise be unaware of reproductive risk and they may not otherwise have access to this information, and, while genetic testing is inherently a complex and ambiguous process, this does not justify non-disclosure. The main motivating factor for non-disclosure was the need for better counseling and informed consent. The data suggest that implementation of an “opt-in/out” policy for parents to decide whether or not to receive incidental findings would be beneficial. The results of this study support the continued disclosure of incidental carrier findings; however, additional research is necessary to further determine and implement the most effective disclosure practices.
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Cohen SA, Tucker ME. Movement of Genetic Counselors from Clinical to Non-clinical Positions: Identifying Driving Forces. J Genet Couns 2018; 27:792-799. [PMID: 29508181 DOI: 10.1007/s10897-018-0242-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
A previous study of genetic counselors (GCs) in the state of Indiana identified movement out of clinical positions within the past 2 years. The aims of this study were to determine if this trend is nationwide and identify reasons why GCs are leaving their positions and factors that might help employers attract and retain GCs. An email was sent to members of the American Board of Genetic Counseling with a link to an online confidential survey. There were 939 responses (23.5% response rate). Overall, 52% of GCs report being highly satisfied in their current position, although almost two thirds think about leaving and one third had changed jobs within the past 2 years. Of those who had changed jobs (n = 295), 74.9% had been working in a hospital/clinic setting but only 46.3% currently do, demonstrating a major shift out of the clinic (p < 0.001). The top three reasons cited for leaving a position were work environment/institutional climate, salary/benefits, and a lack of feeling valued/recognized as a professional. These results confirm that GCs are moving out of clinical positions and document elements of job satisfaction. We suggest points for employers to consider when trying to recruit or retain GCs.
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Affiliation(s)
- Stephanie A Cohen
- Cancer Genetics Risk Assessment Program, St. Vincent Health, 8402 Harcourt Rd #324, Indianapolis, IN, 46260, USA.
| | - Megan E Tucker
- Genetic Counseling Graduate Program, The Center for Genomic Advocacy, Indiana State University, Terre Haute, IN, USA
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10
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Brown S, Puumala S, Leonhard J, Bell M, Flanagan J, Dean LW, Stein Q. Genesurance Counseling: Genetic Counselors' Roles and Responsibilities in Regards to Genetic Insurance and Financial Topics. J Genet Couns 2018; 27:800-13. [PMID: 29204809 DOI: 10.1007/s10897-017-0180-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
While traditional components of genetic counseling sessions are well recognized, less is known about insurance and financial discussions. This study sought to examine "genesurance counseling" which we defined as: that portion of a genetic counseling session, whether intentional or non-intentional, that is devoted to the topic of costs and insurance/third party coverage (particularly for genetic testing). Our objective was to assess genetic counselors' practices and perspective related to genesurance counseling. A survey link was sent by e-mail to members of the National Society of Genetic Counselors (approximately 3100 NSGC members). A total of 571 genetic counselors participated in the survey of which 550 identified as clinical genetic counselors. Survey data were used to investigate differences between specialties, impact on patient rapport, changes in practice dynamics, and devotion of clinic time. Overwhelmingly, 99% of participants acknowledged conducting genesurance counseling, 87% believed it to be part of their job description, and 85% viewed it as an important aspect of genetic counseling. On average, respondents estimated they devoted 10% of their session, or 6 min, to genesurance counseling. Of the surveyed participants, 95% reported genesurance counseling as having some form of influence in a patient's decision regarding genetic testing, and 74% stated that genesurance counseling concerns change the practice and dynamic of their clinic. "Genesurance counseling" is not a topic which has been studied to date. Our study highlights the changes in genetic counselors' roles and responsibilities regarding insurance and financial counseling.
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Laurino MY, Leppig KA, Abad PJ, Cham B, Chu YWY, Kejriwal S, Lee JMH, Sternen DL, Thompson JK, Burgess MJ, Chien S, Elackatt N, Lim JY, Sura T, Faradz S, Padilla C, Paz ECDL, Nauphar D, Nguyen KN, Zayts O, Vu DC, Thong MK. A Report on Ten Asia Pacific Countries on Current Status and Future Directions of the Genetic Counseling Profession: The Establishment of the Professional Society of Genetic Counselors in Asia. J Genet Couns 2017; 27:21-32. [PMID: 28699126 DOI: 10.1007/s10897-017-0115-6] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
The Professional Society of Genetic Counselors in Asia (PSGCA) was recently established as a special interest group of the Asia Pacific Society of Human Genetics. Fostering partnerships across the globe, the PSGCA's vision is to be the lead organization that advances and mainstreams the genetic counseling profession in Asia and ensures individuals have access to genetic counseling services. Its mission is to promote quality genetic counseling services in the region by enhancing practice and curricular standards, research and continuing education. The PSGCA was formally launched during the Genetic Counseling Pre-Conference Workshop held at the 11th Asia-Pacific Conference on Human Genetics in Hanoi, Viet Nam, September 16, 2015. The pre-conference workshop provided an opportunity for medical geneticists and genetic counselors from across 10 Asia Pacific countries to learn about the varied genetic counseling practices and strategies for genetic counseling training. This paper provides an overview of the current status and challenges in these countries, and proposed course of unified actions for the future of the genetic counseling profession.
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Affiliation(s)
- Mercy Y Laurino
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila, Philippines.
- Cancer Prevention Program, Seattle Cancer Care Alliance, 825 Eastlake Ave East Suite 210, Seattle, WA, 98109, USA.
| | - Kathleen A Leppig
- Group Health Cooperative, Seattle, WA, USA
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Peter James Abad
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila, Philippines
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Breana Cham
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yoyo Wing Yiu Chu
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, SAR, China
| | - Saahil Kejriwal
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
- Strand Life Sciences, Bengaluru, India
| | - Juliana M H Lee
- Asia Genomics Pte Ltd, Kuala Lumpur, Malaysia
- Genetic Counseling Asia, Kuala Lumpur, Malaysia
| | - Darci L Sternen
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Matthew J Burgess
- Clinical Genetics Service, Austin Health, Heidelberg, VIC, Australia
| | - Shu Chien
- Genetic Consultation Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Jiin Ying Lim
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thanyachai Sura
- Department of Medicine, Ramathibodi Hospital Medical School, Mahidol University, Bangkok, Thailand
| | - Sultana Faradz
- Master's Program in Genetic Counseling, Diponegoro University, Semarang, Indonesia
| | - Carmencita Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Institute of Human Genetics, National Institute of Health, University of the Philippines Manila, Manila, Philippines
| | - Eva Cutiongco de-la Paz
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Institute of Human Genetics, National Institute of Health, University of the Philippines Manila, Manila, Philippines
| | - Donny Nauphar
- Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia
| | | | - Olya Zayts
- School of English, The University of Hong Kong, Faculty of Arts, Hong Kong, SAR, China
| | - Dung Chi Vu
- National Hospital of Pediatrics, Hanoi, Viet Nam
| | - Meow-Keong Thong
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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12
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Koeller DR, Uhlmann WR, Carere DA, Green RC, Roberts JS; PGen Study Group. Utilization of Genetic Counseling after Direct-to-Consumer Genetic Testing: Findings from the Impact of Personal Genomics (PGen) Study. J Genet Couns 2017; 26:1270-9. [PMID: 28512697 DOI: 10.1007/s10897-017-0106-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
Direct-to-consumer personal genomic testing (DTC-PGT) results lead some individuals to seek genetic counseling (GC), but little is known about these consumers and why they seek GC services. We analyzed survey data pre- and post-PGT from 1026 23andMe and Pathway Genomics customers. Participants were mostly white (91%), female (60%), and of high socioeconomic status (80% college educated, 43% household income of ≥$100,000). After receiving PGT results, 43 participants (4%) made or planned to schedule an appointment with a genetic counselor; 390 (38%) would have used in-person GC had it been available. Compared to non-seekers, GC seekers were younger (mean age of 38 vs 46 years), more frequently had children <18 (26% vs 16%), and were more likely to report previous GC (37% vs 7%) and genetic testing (30% vs 15%). In logistic regression analysis, seeking GC was associated with previous GC use (OR = 6.5, CI = 3.1-13.8), feeling motivated to pursue DTC-PGT for health reasons (OR = 4.3, CI = 1.8-10.1), fair or poor self-reported health (OR = 3.1, CI = 1.1-8.3), and self-reported uncertainty about the results (OR = 1.8, CI = 1.1-2.7). These findings can help GC providers anticipate who might seek GC services and plan for clinical discussions of DTC-PGT results.
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13
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Uhlmann WR, Schwalm K, Raymond VM. Development of a Streamlined Work Flow for Handling Patients' Genetic Testing Insurance Authorizations. J Genet Couns 2017; 26:657-668. [PMID: 28439751 DOI: 10.1007/s10897-017-0098-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/05/2016] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients' genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.
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Affiliation(s)
- Wendy R Uhlmann
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, 300 North Ingalls, NI3 A03, SPC 5419, Ann Arbor, MI, 48109, USA. .,Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA. .,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Katie Schwalm
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Victoria M Raymond
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, 300 North Ingalls, NI3 A03, SPC 5419, Ann Arbor, MI, 48109, USA.,Trovagene Inc., San Diego, CA, USA
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14
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Sinclair S, Raffin-Bouchal S, Venturato L, Mijovic-Kondejewski J, Smith-MacDonald L. Compassion fatigue: A meta-narrative review of the healthcare literature. Int J Nurs Stud 2017; 69:9-24. [PMID: 28119163 DOI: 10.1016/j.ijnurstu.2017.01.003] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Compassion fatigue describes a work-related stress response in healthcare providers that is considered a 'cost of caring' and a key contributor to the loss of compassion in healthcare. OBJECTIVE The purpose of this review was to critically examine the construct of compassion fatigue and to determine if it is an accurate descriptor of work-related stress in healthcare providers and a valid target variable for intervention. DESIGN Meta-narrative review. DATA SOURCES PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases, Google Scholar, the grey literature, and manual searches of bibliographies. REVIEW METHODS Seminal articles and theoretical and empirical studies on compassion fatigue in the healthcare literature were identified and appraised for their validity and relevance to our review. Sources were mapped according to the following criteria: 1) definitions; 2) conceptual analyses; 3) signs and symptoms; 4) measures; 5) prevalence and associated risk factors; and 6) interventions. A narrative account of included studies that critically examines the concept of compassion fatigue in healthcare was employed, and recommendations for practice, policy and further research were made. RESULTS 90 studies from the nursing literature and healthcare in general were included in the review. Findings emphasized that the physical, emotional, social and spiritual health of healthcare providers is impaired by cumulative stress related to their work, which can impact the delivery of healthcare services; however, the precise nature of compassion fatigue and that it is predicated on the provision of compassionate care is associated with significant limitations. The conceptualization of compassion fatigue was expropriated from crisis counseling and psychotherapy and focuses on limited facets of compassion. Empirical studies primarily measure compassion fatigue using the Professional Quality of Life Scale, which does not assess any of the elements of compassion. Reported risk factors for compassion fatigue include job-related factors, fewer healthcare qualifications and less years experience; however, there is no research demonstrating that exemplary compassionate carers are more susceptible to 'compassion fatigue'. CONCLUSION In the last two decades, compassion fatigue has become a contemporary and iconic euphemism that should be critically reexamined in favour of a new discourse on healthcare provider work-related stress.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
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15
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Doyle DL, Awwad RI, Austin JC, Baty BJ, Bergner AL, Brewster SJ, Erby LAH, Franklin CR, Greb AE, Grubs RE, Hooker GW, Noblin SJ, Ormond KE, Palmer CG, Petty EM, Singletary CN, Thomas MJ, Toriello H, Walton CS, Uhlmann WR. 2013 Review and Update of the Genetic Counseling Practice Based Competencies by a Task Force of the Accreditation Council for Genetic Counseling. J Genet Couns 2016; 25:868-79. [PMID: 27333894 DOI: 10.1007/s10897-016-9984-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 05/08/2015] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
The first practice based competencies (PBCs) for the field of genetic counseling were adopted by the American Board of Genetic Counseling (ABGC), 1996. Since that time, there has been significant growth in established and new work settings (clinical and non-clinical) and changes in service delivery models and the roles of genetic counselors. These changes prompted the ABGC to appoint a PBC Task Force in 2011 to review the PBCs with respect to their current relevance and to revise and update them as necessary. There are four domains in the revised PBCs: (I) Genetics Expertise and Analysis (II) Interpersonal, Psychosocial and Counseling Skills (III) Education and (IV) Professional Development and Practice. There are 22 competencies, each clarified with learning objectives or samples of activities and skills; a glossary is included. New competencies were added that address genomics, genetic testing and genetic counselors' roles in risk assessment, education, supervision, conducting research and presenting research options to patients. With PBCs serving as the pre-defined abilities or outcomes of training, graduating genetic counselors will be well prepared to enter the field with a minimum level of skills and abilities. A description of the Task Force's work, key changes and the 2013 PBCs are presented herein.
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Affiliation(s)
- Debra Lochner Doyle
- Screening and Genetics Unit, Washington State Department of Health, 20425 72nd Ave. S., Suite #310, Kent, WA, 98032, USA.
| | | | - Jehannine C Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bonnie J Baty
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Amanda L Bergner
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lori A H Erby
- Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Behavioral Research Branch, The National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Anne E Greb
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, NY, USA
| | - Robin E Grubs
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sarah Jane Noblin
- Department of Obstetrics, Gynecology and Reproductive Services, University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina G Palmer
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth M Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claire N Singletary
- Department of Pediatrics and Obstetrics, Gynecology and Reproductive Services, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Matthew J Thomas
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Carol S Walton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Wendy R Uhlmann
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
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16
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Rabideau MM, Wong K, Gordon ES, Ryan L. Genetic Counselors in Startup Companies: Redefining the Genetic Counselor Role. J Genet Couns 2016; 25:649-57. [PMID: 26801784 DOI: 10.1007/s10897-015-9923-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/04/2015] [Indexed: 11/25/2022]
Abstract
Genetic counselors (GCs) have recently begun moving into non-clinic based roles in increasing numbers. A relatively new role for GCs is working for startup companies. Startups are newly established companies in the phase of developing and researching new scalable businesses. This article explores the experiences of four GCs working at different startup companies and aims to provide resources for GCs interested in learning more about these types of roles. The article describes startup culture, including a relatively flat organizational structure, quick product iterations, and flexibility, among other unique cultural characteristics. Financial considerations are described, including how to understand and evaluate a company's financial status, along with a brief explanation of alternate forms of compensation including stock options and equity. Specifically, the article details the uncertainties and rewards of working in a fast-paced startup environment that affords opportunities to try new roles and use the genetic counseling skill set in new ways. This article aims to aid GCs in determining whether a startup environment would be a good fit, learning how to evaluate a specific startup, and understanding how to market themselves for positions at startups.
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Affiliation(s)
- Marina M Rabideau
- Invitae Corporation, 475 Brannan St., San Francisco, CA, 94107, USA.
| | - Kenny Wong
- Counsyl Inc., South San Francisco, CA, USA
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17
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Quinn GP, Peshkin BN, Sehovic I, Bowman M, Tamargo C, Vadaparampil ST. Oncofertility in adolescent and young adult hereditary cancer: Considerations for genetics professionals. World J Med Genet 2015; 5:52-59. [DOI: 10.5496/wjmg.v5.i4.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/07/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Adolescents and young adults (AYA) with a cancer diagnosis or those at risk for cancer due to hereditary cancer syndromes may benefit from genetic counseling and testing not only to manage personal risk but also to address reproductive concerns, especially fertility. The opportunity for genetic counselors to provide important risk information is relevant to both the newly diagnosed as well as to unaffected carriers and survivors. However, genetic counselors may need additional training in reproductive options related to AYA cancer to provide this valuable counsel. This commentary uses hereditary breast and ovarian cancer syndrome as a model to highlight important considerations when discussing preimplanatation genetic diagnosis and prenatal diagnosis, particularly in the context of expanded testing for hereditary cancer risk including multigene panels or whole exome or whole genome sequencing. Other hereditary cancers are also addressed; however, less is known about the psychosocial and fertility concerns in these AYA populations. Additionally, we provide an overview of the concept of “oncofertility” - the linkage between cancer care and reproductive medicine that aims to expand the reproductive opportunities of cancer patients - and offer support for the expansion of guidelines to include genetic counselors in AYA cancer patients’ treatment planning related to reproductive health and fertility.
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18
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Valverde K, Mueller R, Paciotti B, Conway L. An Exploratory Study of Employers' Attitudes Towards a Clinical Doctorate in Genetic Counseling. J Genet Couns 2015; 25:179-88. [PMID: 26165833 DOI: 10.1007/s10897-015-9856-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/06/2014] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
Abstract
Creation of an advanced degree in genetic counseling has been considered since the early 1980s. The Genetic Counseling Advanced Degree Task Force (GCADTF) was convened in 2012 to formally explore the potential suitability of a clinical doctorate (ClinD), though employer perspectives of advanced training were not part of the discussion. The conclusion of this group was that the field was not ready to move to an entry-level clinical doctorate at this time but that further education and research among other stakeholders was necessary (Nagy et al. 2014). In this study, we describe employers' perspectives on developing a clinical doctorate in genetic counseling based upon thirty audio-recorded semi-structured phone interviews that were transcribed verbatim and qualitatively analyzed. Overall, employers expressed concerns regarding the economic viability of ClinD training but envisioned expanded roles for genetic counselors (especially in areas of education and research) and enhanced credibility. While some employers reported that they would provide flexibility and tuition assistance for acquisition of a ClinD, for many employers, support was contingent on perceived value of the degree. Some employers were not clear about the difference between a ClinD and a PhD, suggesting that there is a need for educating employers about advanced degree options for the genetic counseling field. Future research could include investigating employer attitudes about market needs, envisioned roles, and compensation formulas for counselors with a ClinD or other forms of advanced training.
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Affiliation(s)
- Kathleen Valverde
- Genetic Counseling Program, Arcadia University, 450 S. Easton Road, Glenside, PA, 19038, USA.
| | - Rebecca Mueller
- Department of the History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Breah Paciotti
- Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Conway
- Genetic Counseling Program, Arcadia University, 450 S. Easton Road, Glenside, PA, 19038, USA
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19
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Ahram M, Soubani M, Abu Salem L, Saker H, Ahmad M. Knowledge, Attitudes, and Practice Regarding Genetic Testing and Genetic Counselors in Jordan: A Population-Based Survey. J Genet Couns 2015; 24:1001-10. [PMID: 25851945 DOI: 10.1007/s10897-015-9839-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/24/2015] [Indexed: 12/15/2022]
Abstract
Genetic testing has a potential in the prevention of genetic diseases, particularly in communities with high rates of consanguineous marriage. Therefore, knowledge, practice, and attitudes of the public in Jordan regarding genetic testing were investigated. Individuals (N = 3,196) were questioned about the concepts of genetic testing and genetic counselors, if they underwent any genetic tests, the type of test, the method of consenting to the test, as well as their level of satisfaction with the privacy of the genetic testing service. The likelihood of pursuing predictive genetic testing for cancer was also investigated. Although almost 70 % of respondents knew the term "genetic testing," only 18 % had undergone genetic testing, primarily the mandatory premarital test. In addition, there was a lack of general knowledge about genetic counselors. Many of those who had genetic testing (45 %) indicated they did not go through a consent process, and a lack of consent was significantly related to dissatisfaction with the privacy of the service. Approximately 55 % of respondents indicated they would potentially pursue predictive genetic testing for cancer. Going for routine health checkups was not significantly correlated with either actual or potential uptake of genetic testing, suggesting health care providers do not play an influential role in patients' testing decisions. Our results show a gap between the knowledge and uptake of genetic testing and may help to guide the design of effective strategies to initiate successful genetic counseling and testing services.
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Affiliation(s)
- Mamoun Ahram
- Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | - Majd Soubani
- Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Lana Abu Salem
- Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Haneen Saker
- Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Muayyad Ahmad
- Department of Clinical Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
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