Pilot study of a decision aid on BRCA1/2 genetic testing among Orthodox Jewish women

INTRODUCTION

Orthodox Jewish women face unique social, cultural, and religious factors that may influence uptake of BRCA1/2 genetic testing. We examined the impact of a web-based decision aid (DA) on BRCA1/2 genetic testing intention/completion among Orthodox Jewish women. We conducted a single-arm pilot study among 50 Orthodox Jewish women who were given access to a web-based DA entitled RealRisks and administered serial surveys at baseline and 1 and 6 months after exposure to the DA. Descriptive statistics were conducted for baseline characteristics and study measures. Comparisons were made to assess changes in study measures over time. Fifty Orthodox Jewish women enrolled in the study with a mean age of 43.9 years (standard deviation [SD] 14.6), 70% Modern Orthodox, 2% with personal history of breast cancer, and 68% and 16% with a family history of breast or ovarian cancer, respectively. At baseline, 27 (54%) participants intended to complete genetic testing. Forty-three participants (86%) completed RealRisks and the 1-month survey and 38 (76%) completed the 6-month survey. There was a significant improvement in BRCA1/2 genetic testing knowledge and decrease in decisional conflict after exposure to the DA. At 1 month, only 20 (46.5%) completed or intended to complete genetic testing (p = 0.473 compared to baseline). While the DA improved genetic testing knowledge and reduced decisional conflict, genetic testing intention/completion did not increase over time. Future interventions should directly address barriers to BRCA1/2 genetic testing uptake and include input from leaders in the Orthodox Jewish community.

CLINICALTRIALS

GOV ID

NCT03624088 (8/7/18).

"We're potentially worsening health inequalities": Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability

A polio booster campaign targeting all children aged 1-9 was implemented across London between August-December 2022 as part of a national enhanced poliovirus incident response. Orthodox Jewish (OJ) children were particularly vulnerable to transmission due to disparities in childhood vaccination coverage and the transnational spread of poliovirus affecting linked populations in New York and Israel. This study aimed to evaluate how the polio booster campaign was tailored to increase uptake and enable access for OJ families in northeast and north central London boroughs, and the impact of the campaign on local-level vaccine inequities. Semi-structured in-depth interviews (n = 36) were conducted with participants involved in the implementation and delivery of the polio booster campaign, and OJ mothers. Site visits (n = 5) were conducted at vaccine clinics, and rapid interviews (n = 26) were held to explore parental perceptions of the poliovirus incident and childhood immunisations. Enablers to vaccination during the campaign included the production of targeted printed communications and offering flexible clinic times in primary care settings or complementary delivery pathways embedded in family-friendly spaces. Barriers included digital booking systems. Mothers reported being aware of the poliovirus incident, but the majority of those interviewed did not feel their children were at risk of contracting polio. Healthcare provider participants raised concerns that the vaccine response had limited impact on reducing disparities in vaccine uptake. While OJ families were recognised as a priority for public health engagement during the poliovirus incident response, this evaluation identified limitations in reducing transmission vulnerability during the booster campaign. Lessons for future campaign delivery include effectively conveying transmission risk and the urgency to vaccinate. Priorities for mitigating vaccine inequities include public engagement to develop messaging strategies and strengthening the capacity of primary care and complementary delivery pathways to serve families with higher-than-average numbers of children.

Intimate Partner Violence in an Orthodox Jewish Community in the United States: A Qualitative Exploration of Community Members' Perspectives

This study sought to understand the needs and priorities of the Orthodox Jewish community around intimate partner violence in a medium-sized midwestern city. Twelve Orthodox Jewish rabbis, Rebbetzins, and community members (including survivors) were recruited to participate in in-depth, semistructured interviews. Interviews were analyzed using Dedoose via a mixed content analysis approach. Interviews revealed four themes: (1) Orthodox Gender Norms and Socialization: Risk or Protective Factor? (2) Awareness of DV Services in the Community; (3) Barriers to help-seeking; and (4) Salience of Rabbis and Rebbetzins. Recommendations for culturally congruent programs and practices are discussed.

Knowledge and Attitudes Toward Covid-19 and Vaccines Among a New York Haredi-Orthodox Jewish Community

The Covid-19 pandemic has exposed the difficulty of the US public health system to respond effectively to vulnerable subpopulations, causing disproportionate rates of morbidity and mortality. New York Haredi-Orthodox Jewish communities represent a group that have been heavily impacted by Covid-19. Little research has examined their experience or perceptions toward Covid-19 and vaccines. We conducted a cross-sectional, observational study to explore the experience of Covid-19 among Haredim. Paper surveys were self-administered between December 2020 and January 2021 in Haredi neighborhood pediatricians' offices in Brooklyn, New York. Of 102 respondents, 43% reported either a positive SARS-CoV-2 viral or antibody test. Participants trusted their physicians, Orthodox medical organizations, and rabbinic leaders for medical information. Knowledge of Covid-19 transmission and risk was good (69% answered ≥ 4/6 questions correctly). Only 12% of respondents would accept a Covid-19 vaccine, 41% were undecided and 47% were strongly hesitant. Independent predictors of strong vaccine hesitancy included believing natural infection to be better than vaccination for developing immunity (adjusted odds ratio [aOR] 4.28; 95% confidence interval [CI] 1.23-14.86), agreement that prior infection provides a path toward resuming communal life (aOR 4.10; 95% CI 1.22-13.77), and pandemic-related loss of trust in physicians (aOR 5.01; 95% CI 1.05-23.96). The primary disseminators of health information for self-protective religious communities should be stakeholders who understand these groups' unique health needs. In communities with significant Covid-19 experience, vaccination messaging may need to be tailored toward protecting infection-naïve individuals and boosting natural immunity against emerging variants.

Can Orthodox Jewish Patients Undergo Palliative Extubation? A Challenging Ethics Case Study

According to Jewish law/ethics, continuous life-sustaining therapy may not be withdrawn after its introduction, unless the patient has improved and no longer has a medical indication for the treatment. We report the case of an 88-year-old Orthodox Jewish patient, on invasive mechanical ventilation, with severe anoxic brain injury after multiple cardiac arrests. Although the patient's son informed the palliative care team that his father did not want to be in pain or to linger in a vegetative state when terminally ill, the mechanical ventilation was keeping him alive with a poor neurological prognosis. Additionally, the patient had previously stated his wish to observe Orthodox Jewish principles regarding end-of-life care. After extensive discussion, the family Rabbi clarified that it would be acceptable to withdraw mechanical ventilation if there were a "reasonable expectation" he would breathe on his own for a "reasonable amount of time." Thus, if the patient's death were to occur, it would not be an immediate consequence the normal ventilator weaning process. Following intermediation by the hospital Rabbi, the definition of what would be a "reasonable expectation" and "reasonable amount of time" was established by the family Rabbi as "over 50%" and "on the order of hours," respectively. Following pulmonary consultation, the patient underwent palliative extubation and, 12 hours after the procedure, died comfortably surrounded by the family. In conclusion, the collaborative and interdisciplinary work among the family Rabbi, hospital Rabbi, and the various medical teams allowed the development of a plan that met all of the patient's personal and religious wishes and beliefs.

Improving mental health knowledge of the Charedi Orthodox Jewish Community in North London: A partnership project

INTRODUCTION

This article describes a successful community-based partnership project between statutory and third-sector services targeting the strictly Orthodox Jewish community (OJC).

METHODS

The City and Hackney Black and Minority Ethnic (BME) Access Service (East London NHS Foundation Trust (ELFT)) collaborated with Bikur Cholim, a local third-sector organisation based in the heart of a north London Charedi OJC, to develop a brief culturally tailored psychoeducational group intervention focusing on mental health promotion and prevention. In total, 34 carers in the Charedi OJC were provided with general information on mental health, the availability of support services and self-care.

RESULTS

Overall improvements in well-being, increased intentions to access services, particularly talking therapies, and qualitative feedback indicated that the group was very well received.

CONCLUSION

The project endorses the value of culturally relevant psychoeducation, enabling suggestions for culturally appropriate service development.