1
|
Dwyer AA, Shen H, Zeng Z, Gregas M, Zhao M. Framing Effects on Decision-Making for Diagnostic Genetic Testing: Results from a Randomized Trial. Genes (Basel) 2021; 12:genes12060941. [PMID: 34202935 PMCID: PMC8234313 DOI: 10.3390/genes12060941] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Genetic testing is increasingly part of routine clinical care. However, testing decisions may be characterized by regret as findings also implicate blood relatives. It is not known if genetic testing decisions are affected by the way information is presented (i.e., framing effects). We employed a randomized factorial design to examine framing effects on hypothetical genetic testing scenarios (common, life-threatening disease and rare, life-altering disease). Participants (n = 1012) received one of six decision frames: choice, default (n = 2; opt-in, opt-out), or enhanced choice (n = 3, based on the Theory of Planned Behavior). We compared testing decision, satisfaction, regret, and decision cognitions across decision frames and between scenarios. Participants randomized to ‘choice’ were least likely to opt for genetic testing compared with default and enhanced choice frames (78% vs. 83–91%, p < 0.05). Neither satisfaction nor regret differed across frames. Perceived autonomy (behavioral control) predicted satisfaction (B = 0.085, p < 0.001) while lack of control predicted regret (B = 0.346, p < 0.001). Opting for genetic testing did not differ between disease scenarios (p = 0.23). Results suggest framing can nudge individuals towards opting for genetic testing. These findings have important implications for individual self-determination in the genomic era. Similarities between scenarios with disparate disease trajectories point to possible modular approaches for web-based decisional support.
Collapse
Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA
- Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-617-522-1711
| | - Hongjie Shen
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Ziwei Zeng
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Matt Gregas
- Department of Research Services, Boston College, Chestnut Hill, MA 02467, USA;
| | - Min Zhao
- Carroll School of Management, Boston College, Chestnut Hill, MA 02467, USA;
| |
Collapse
|
2
|
Martin AP, Downing J, Collins B, Godman B, Alfirevic A, Greenhalgh KL, Pirmohamed M. Examining the uptake of predictive BRCA testing in the UK; findings and implications. Eur J Hum Genet 2021; 29:699-708. [PMID: 33328582 PMCID: PMC8115171 DOI: 10.1038/s41431-020-00783-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/08/2022] Open
Abstract
Predictive BRCA testing is offered to asymptomatic individuals to predict future risk where a variant has been identified in a relative. It is uncertain whether all eligible relatives access testing, and whether this is related to health care inequalities. Our aim was to analyse trends and inequalities in uptake of testing, and identify predictors of testing and time-to-receipt of testing. A database from April 2010 to March 2017 was collated. Multivariate analysis explored individual associations with testing. Predictor variables included gender, BRCA test type, cancer history, Index of Multiple Deprivation (IMD) and education status. To evaluate factors associated with time-to-testing, a Cox proportional-hazards (CP) model was used. Of 779 tests undertaken, 336 (43.1%) were identified with a BRCA variant. A total of 537 (68.9%) were female and in 83.4% (387/464) of probands, predictive testing was received by relatives. Analysis identified inequalities since decreased testing was found when the proband was unaffected by cancer (OR 0.14, 95% CI 0.06-0.33). Median time-to-testing was 390 days (range, 0-7090 days) and the CP model also identified inequalities in the hazard ratio (HR) for testing for people aged >40 was higher than for aged <40 (HR 1.41, 95% CI 1.20-1.67) and BRCA2 testing was higher than for BRCA1 testing (HR 1.39, 95% CI 1.18-1.64). Reduced testing was found when probands were unaffected by cancer and time-to-testing was found to vary by age and BRCA1/2 test. Given limited study sample size, further research is recommended to examine inequalities in predictive BRCA testing.
Collapse
Affiliation(s)
- Antony P Martin
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK.
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK.
| | - Jennifer Downing
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Ana Alfirevic
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | | | - Munir Pirmohamed
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
3
|
Leitsalu L, Palover M, Sikka TT, Reigo A, Kals M, Pärn K, Nikopensius T, Esko T, Metspalu A, Padrik P, Tõnisson N. Genotype-first approach to the detection of hereditary breast and ovarian cancer risk, and effects of risk disclosure to biobank participants. Eur J Hum Genet 2021; 29:471-481. [PMID: 33230308 PMCID: PMC7940387 DOI: 10.1038/s41431-020-00760-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
Genotype-first approach allows to systematically identify carriers of pathogenic variants in BRCA1/2 genes conferring a high risk of familial breast and ovarian cancer. Participants of the Estonian biobank have expressed support for the disclosure of clinically significant findings. With an Estonian biobank cohort, we applied a genotype-first approach, contacted carriers, and offered return of results with genetic counseling. We evaluated participants' responses to and the clinical utility of the reporting of actionable genetic findings. Twenty-two of 40 contacted carriers of 17 pathogenic BRCA1/2 variants responded and chose to receive results. Eight of these 22 participants qualified for high-risk assessment based on National Comprehensive Cancer Network criteria. Twenty of 21 counseled participants appreciated being contacted. Relatives of 10 participants underwent cascade screening. Five of 16 eligible female BRCA1/2 variant carriers chose to undergo risk-reducing surgery, and 10 adhered to surveillance recommendations over the 30-month follow-up period. We recommend the return of results to population-based biobank participants; this approach could be viewed as a model for population-wide genetic testing. The genotype-first approach permits the identification of individuals at high risk who would not be identified by application of an approach based on personal and family histories only.
Collapse
Affiliation(s)
- Liis Leitsalu
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Marili Palover
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Timo Tõnis Sikka
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Anu Reigo
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mart Kals
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Kalle Pärn
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Tiit Nikopensius
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Tõnu Esko
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andres Metspalu
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Peeter Padrik
- Hematology and Oncology Clinic, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Neeme Tõnisson
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia.
- Dept. of Clinical Genetics, United Laboratories, Tartu University Hospital, Tartu, Estonia.
| |
Collapse
|
4
|
Stefansdottir V, Thorolfsdottir E, Hognason HB, Patch C, van El C, Hentze S, Cordier C, Mendes Á, Jonsson JJ. Web-based return of BRCA2 research results: one-year genetic counselling experience in Iceland. Eur J Hum Genet 2020; 28:1656-1661. [PMID: 32523053 PMCID: PMC7784695 DOI: 10.1038/s41431-020-0665-1] [Citation(s) in RCA: 6] [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: 11/12/2019] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022] Open
Abstract
There is an increased pressure to return results from research studies. In Iceland, deCODE Genetics has emphasised the importance of returning results to research participants, particularly the founder pathogenic BRCA2 variant; NM_000059.3:c.771_775del. To do so, they opened the website www.arfgerd.is . Individuals who received positive results via the website were offered genetic counselling (GC) at Landspitali in Reykjavik. At the end of May 2019, over 46.000 (19% of adults of Icelandic origin) had registered at the website and 352 (0.77%) received text message informing them about their positive results. Of those, 195 (55%) contacted the GC unit. Additionally, 129 relatives asked for GC and confirmatory testing, a total of 324 individuals. Various information such as gender and age, prior knowledge of the variant and perceived emotional impact, was collected. Of the BRCA2 positive individuals from the website, 74 (38%) had prior knowledge of the pathogenic variant (PV) in the family. The majority initially stated worries, anxiety or other negative emotion but later in the process many communicated gratitude for the knowledge gained. Males represented 41% of counsellees as opposed to less than 30% in the regular hereditary breast and ovarian (HBOC) clinic. It appears that counselling in clinical settings was more reassuring for worried counsellees. In this article, we describe one-year experience of the GC service to those who received positive results via the website. This experience offers a unique opportunity to study the public response of a successful method of the return of genetic results from research.
Collapse
Affiliation(s)
- Vigdis Stefansdottir
- Department of Genetics and Molecular Medicine, Iceland, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland.
| | - Eirny Thorolfsdottir
- Department of Genetics and Molecular Medicine, Iceland, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Hakon B Hognason
- Department of Genetics and Molecular Medicine, Iceland, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Christine Patch
- Florence Nightingale Faculty, Nursing and Midwifery & Palliative Care, King's College London, London, UK
| | - Carla van El
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Genetics and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Christophe Cordier
- Association suisse des conseillers en génétique, c/o Anne Murphy, 26 rue de la Colline, 1205, Genève, Switzerland
- Département de génétique, SYNLAB, Chemin d'Entre-Bois 21, 1018, Lausanne, Switzerland
| | - Álvaro Mendes
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jon J Jonsson
- Department of Genetics and Molecular Medicine, Iceland, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Iceland, Reykjavik 101, Reykjavik, Iceland
| |
Collapse
|
5
|
Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Carrera P, Campos C, Anderson L, Luta G, Peshkin BN, Schwartz MD, Cupertino AP, Gonzalez N, Sheppard VB. Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer. Int J Environ Res Public Health 2019; 16:E4793. [PMID: 31795362 PMCID: PMC6926842 DOI: 10.3390/ijerph16234793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022]
Abstract
Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.
Collapse
Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Claudia Campos
- Nueva Vida, DC Office—801 N Pitt St., Suite 113, Alexandria, VA 22314, USA;
| | - Lyndsay Anderson
- College of Health and Human Services, School of Nursing, California State University, Sacramento, CA 95819, USA;
| | - George Luta
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Department of Biostatistics, Bioinformatics and Biomathematics, 4000 Reservoir Rd., NW, Washington, DC 20057, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, 40 Prospect Avenue, Office number 316, Hackensack, NJ 07601, USA;
| | - Nathaly Gonzalez
- Capital Breast Care Center, 1000 New Jersey Ave, SE, Washington, DC 20003, USA;
| | - Vanessa B. Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Massey Cancer Center, Office of Health Equity and Disparities Research, Richmond, VA 23298, USA
| |
Collapse
|
6
|
Brédart A, Kop JL, Dick J, Cano A, De Pauw A, Anota A, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study. BMJ Open 2019; 9:e029926. [PMID: 31551380 PMCID: PMC6773290 DOI: 10.1136/bmjopen-2019-029926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES AND SETTING Advances in multigene panel testing for cancer susceptibility has increased the complexity of counselling, requiring particular attention to counselees' psychosocial needs. Changes in psychosocial problems before and after genetic testing were prospectively compared between genetic test results in women tested for breast or ovarian cancer genetic susceptibility in French, German and Spanish clinics. PARTICIPANTS AND MEASURES Among 752 counselees consecutively approached, 646 (86%) were assessed after the initial genetic consultation (T1), including 510 (68%) affected with breast cancer, of which 460 (61%) were assessed again after receiving the test result (T2), using questionnaires addressing genetic-specific psychosocial problems (Psychosocial Aspects of Hereditary Cancer (PAHC)-six scales). Sociodemographic and clinical data were also collected. RESULTS Seventy-nine (17.2%), 19 (4.1%), 259 (56.3%), 44 (9.6%) and 59 (12.8%) women received a BRCA1/2, another high/moderate-risk pathogenic variant (PV), negative uninformative, true negative (TN) or variant of uncertain significance result (VUS), respectively. On multiple regression analyses, compared with women receiving another result, those with a VUS decreased more in psychosocial problems related to hereditary predisposition (eg, coping with the test result) (ß=-0.11, p<0.05) and familial/social issues (eg, risk communication) (ß=-0.13, p<0.05), almost independently from their problems before testing. Women with a PV presented no change in hereditary predisposition problems and, so as women with a TN result, a non-significant increase in familial/social issues. Other PAHC scales (ie, emotions, familial cancer, personal cancer and children-related issues) were not affected by genetic testing. CONCLUSIONS In women tested for breast or ovarian cancer genetic risk in European genetics clinics, psychosocial problems were mostly unaffected by genetic testing. Apart from women receiving a VUS result, those with another test result presented unchanged needs in counselling in particular about hereditary predisposition and familial/social issues.
Collapse
Affiliation(s)
- Anne Brédart
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- Psychopathology and Health Process Laboratory, University Paris Descartes, Boulogne-Billancourt, Paris, France
| | - Jean-Luc Kop
- Département de Psychologie, Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Amélie Anota
- French National Quality of Life in Oncology Platform, and Methodology; Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Joan Brunet
- Medical Oncology Department, Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Division of Pathology; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Sylvie Dolbeault
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
| |
Collapse
|
7
|
Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
Collapse
Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
8
|
Suttman A, Pilarski R, Agnese DM, Senter L. "Second-Class Status?" Insight into Communication Patterns and Common Concerns Among Men with Hereditary Breast and Ovarian Cancer Syndrome. J Genet Couns 2018; 27:885-893. [PMID: 29404823 DOI: 10.1007/s10897-018-0214-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/20/2017] [Accepted: 01/09/2018] [Indexed: 01/06/2023]
Abstract
Hereditary breast and ovarian cancer syndrome (HBOC) is a cancer predisposition syndrome that affects both men and women, with more significant cancer risk elevations in women. Dissemination patterns regarding familial genetic risk information among females with HBOC are fairly well defined, but knowledge about how males share this information is limited. We interviewed 21 people primarily Ashkenazi Jewish men who were accrued via listserv email through Facing Our Risk of Cancer Empowered (FORCE). Interviews focused on family cancer history, experiences with cancer and genetic testing, motivations to pursue genetic testing and subsequently disclose genetic test results, information-sharing patterns, health care provider response, and participants' emotional support systems. The interviews were transcribed in their entirety, coded, and analyzed based on recurring themes. Eighteen transcripts were used for the analysis. Results were classified into five main themes. Participants (n = 8) were most concerned about cancer risk for their children and female family members, and most (n = 11) mentioned that HBOC provides them increased personal awareness, but has a negligible impact on their life overall (n = 9). Men (n = 11) were interested in a male-focused support group to discuss HBOC and gain knowledge and information. Participants (n = 9) took on active and open communication roles with family members and health care providers. The majority of participants (n = 14) discussed the need for knowledge and awareness among the health care community and general population regarding male HBOC risks. This study serves as a pilot study and provides important and novel insights into psychosocial impacts, communication patterns, encounters with health care professionals, and expressed needs of males with HBOC.
Collapse
Affiliation(s)
- Alexandra Suttman
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Pediatrics, Department of Hematology, Oncology, and Bone Marrow Transplant, Children's Hospital Colorado, 13123 E. 16th Ave, B115, Aurora, CO, 80045, USA.
| | - Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Doreen M Agnese
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
9
|
Solomons NM, Lamb AE, Lucas FL, McDonald EF, Miesfeldt S. Examination of the Patient-Focused Impact of Cancer Telegenetics Among a Rural Population: Comparison with Traditional In-Person Services. Telemed J E Health 2017; 24:130-138. [PMID: 28737998 DOI: 10.1089/tmj.2017.0073] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telecommunication models promise to improve access to cancer genetic counseling. Little is known about their impact among the geographically underserved. This work examined knowledge and emotional outcomes and attitudes/beliefs regarding cancer telegenetic services (via live-interactive videoconferencing) in Maine. MATERIALS AND METHODS Cancer telegenetic patients seen at two remote sites and control (in-person) patients responded to pre-/postsurveys assessing care impact on hereditary breast and ovarian cancer (HBOC) knowledge and emotional health, ease of access to services, and telegenetics satisfaction/acceptability. RESULTS 158/174 (90%) participants returned pre- and immediate postcounseling surveys (90 remote and 68 in-person). Fewer returned 1-month postsurveys. Remote patients were older with lower education levels, more likely to live in rural counties and to have cancer histories. The two groups were matched relative to gender, race, and health insurance status. HBOC knowledge improved equally in both groups pre- versus immediately postcounseling and was maintained at 1 month in both groups. Decreased anxiety was evident postcounseling with no significant difference between groups. Depression improved significantly in remote patients immediately postcounseling; 1-month depression measures were lower in both groups. The availability of telegenetics eased transportation needs/work absences, and patients reported satisfaction with telecommunication quality. Despite overall acceptance of telegenetics, 32% of remote patients noted preference for in-person care. CONCLUSIONS There were few differences in HBOC knowledge and emotional outcomes comparing traditional in-person cancer genetic services with telegenetics, and satisfaction with/acceptance of this model was high. These data relate to scalability of cancer telegenetics in rural regions regionally and nationally.
Collapse
Affiliation(s)
- Nan M Solomons
- 1 Health Informatics Programs, College of Graduate and Professional Studies, University of New England , Portland, Maine
| | - Amanda E Lamb
- 2 Maine Medical Center Cancer Institute , Maine Medical Center, Scarborough, Maine
| | - Frances L Lucas
- 3 Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Maine Medical Center, Portland, Maine
| | - Eileen F McDonald
- 4 The Center for Genetics and Prevention, Dana Farber Cancer Institute , Boston, Massachusetts
| | - Susan Miesfeldt
- 2 Maine Medical Center Cancer Institute , Maine Medical Center, Scarborough, Maine
| |
Collapse
|
10
|
Hooker GW, Clemens KR, Quillin J, Vogel Postula KJ, Summerour P, Nagy R, Buchanan AH. Cancer Genetic Counseling and Testing in an Era of Rapid Change. J Genet Couns 2017; 26:1244-1253. [PMID: 28434142 DOI: 10.1007/s10897-017-0099-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/28/2016] [Accepted: 04/10/2017] [Indexed: 01/19/2023]
Abstract
The impacts of the Association for Molecular Pathology vs. Myriad Supreme Court decision regarding patenting DNA segments and multi-gene testing on cancer genetic counseling practice have not been well described. We aimed to assess genetic counselors' perceptions of how their genetic testing-related practices for hereditary breast and/or ovarian cancer (HBOC) changed after these events. One-hundred fifty-two genetic counselors from the National Society of Genetic Counselors Cancer Special Interest Group completed an anonymous, online, mixed-methods survey in November 2013. The survey presented four hypothetical patients and asked about changes in testing practice. Across the vignettes, a majority of participants reported specific changes in testing decisions following Association for Molecular Pathology vs. Myriad and availability of multi-gene testing. Ninety-three percent of participants reported changing the types of first- and second-line tests they order for HBOC; the degree of change varied geographically. Qualitative analysis indicated that some counselors have altered the counseling session content, trading depth of information for breadth and spending more time counseling about uncertainty. This study shows that cancer genetic counselors are adapting quickly to genetic testing changes, but with wide variability. Findings suggest future research to elucidate clinicians' and patients' preferences for guidance on the clinical implementation of next-generation sequencing.
Collapse
Affiliation(s)
| | | | - John Quillin
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | | |
Collapse
|
11
|
Augestad MT, Høberg-Vetti H, Bjorvatn C, Sekse RJT. Identifying Needs: a Qualitative Study of women's Experiences Regarding Rapid Genetic Testing for Hereditary Breast and Ovarian Cancer in the DNA BONus Study. J Genet Couns 2016; 26:182-189. [PMID: 27465808 PMCID: PMC5258794 DOI: 10.1007/s10897-016-9996-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 07/08/2016] [Indexed: 12/22/2022]
Abstract
Genetic testing for hereditary breast and ovarian cancer is increasingly being offered in newly diagnosed breast and ovarian cancer patients. This genetic information may influence treatment decisions. However, there are some concerns that genetic testing offered in an already vulnerable situation might be an extra burden to these women. The aim of this study was to explore the experiences of women who had been offered and accepted genetic testing when newly diagnosed with breast or ovarian cancer. Four semi-structured focus-group interviews were conducted with 17 women recruited from a Norwegian multicenter study. The material was condensed, and conventional qualitative analysis was used to identify patterns in the participants’ descriptions. Three core themes were identified: 1) being “beside oneself” 2) altruism and ethical dilemmas 3) the need for support and counselling to assist the decision process. The present study indicates that women who are offered genetic testing when newly diagnosed with breast or ovarian cancer want a consultation with a health professional. Personalized support and counselling might empower women to improve their ability to manage and comprehend this overwhelming situation, and find meaning in this experience.
Collapse
Affiliation(s)
- Mirjam Tonheim Augestad
- Western Norway Familial Cancer Center, Haukeland University Hospital, Haukelandsveien 22, P.O. Box 1400, N-5021, Bergen, Norway.
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Hildegunn Høberg-Vetti
- Western Norway Familial Cancer Center, Haukeland University Hospital, Haukelandsveien 22, P.O. Box 1400, N-5021, Bergen, Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Cathrine Bjorvatn
- Western Norway Familial Cancer Center, Haukeland University Hospital, Haukelandsveien 22, P.O. Box 1400, N-5021, Bergen, Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild Johanne Tveit Sekse
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
12
|
Castejón V, Rovira T, Sumalla EC, Darder E, Iglesias S, Ochoa C, Blanco I. [Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer]. Med Clin (Barc) 2016; 146:148-54. [PMID: 26654557 DOI: 10.1016/j.medcli.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/28/2015] [Revised: 07/27/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Having an inherited predisposition to cancer may have a psychological impact, and one goal of genetic counseling is to promote psychological adjustment to the new situation. Thus, in the genetic context, validated measures of adjustment are required. Given that self-concept is a good indicator of adjustment to the disease or to the risk for it, and a relevant variable in oncology, the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale. MATERIAL AND METHOD One hundred and sixty-five BRCA carriers' women answered to the questionnaire, previously adapted through a process of forward/back-translation, and to the Cancer Worry Scale (CWS) as a measure of convergent validity. Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges, and submitted to a confirmatory factor analysis (CFA). Cronbach's α was calculated for each subscale (Stigma, Vulnerability and Control), and correlations with CWS were performed. RESULTS Expert judges' structure and CFA do not support the original structure of the questionnaire. The respecificity model (with items 10 and 13 loading on Vulnerability factor) show a better fit: comparative fit index 0.973; Tucker-Lewis index 0.968; root mean square error of approximation 0.067. The Cronbach's α is 0.83 for Stigma, 0.84 for Vulnerability, and 0.61 for Control. Evidence of convergent validity with CWS has been obtained (Spearman's rho 0.631 for Stigma, 0.683 for Vulnerability, and -0.363 for Control; P<.001). CONCLUSIONS Results support the validity of the modified Spanish BRCA Self-Concept Scale, which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer.
Collapse
Affiliation(s)
- Vanessa Castejón
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Tatiana Rovira
- Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Enric C Sumalla
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Esther Darder
- Programa de Cáncer Hereditario, Institut Català d'Oncologia-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Unidad de Consejo Genético, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Silvia Iglesias
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Cristian Ochoa
- Unidad de Psico-Oncología, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, España
| | - Ignacio Blanco
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Programa de Asesoramiento y Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
| |
Collapse
|
13
|
Bit-Sava EM. [Genetical aspects of surgical treatment in patients with hereditary breast cancer]. Vestn Khir Im I I Grek 2014; 173:27-30. [PMID: 25823331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Numerous available results of investigations confirmed the important role of prophylactic bilateral laparoscopic salpingo-oophorectomy and contralateral prophylactic subcutaneous mastectomy in decrease of risks of malignant tumors of the reproductive system when mutation carriers of BRCA1 and BRCA2 presented. Recommendations to surgical treatment of hereditary breast cancer are considered as a very difficult task which should be based on risks and advantages of prophylactic surgical interventions. Presented surgical operations could be applied in mutation carriers of reparation DNA genes and patients with hereditary breast cancer aimed to improve the indices of general survival rate and quality of life.
Collapse
|
14
|
Stan DL, Shuster LT, Wick MJ, Swanson CL, Pruthi S, Bakkum-Gamez JN. Challenging and complex decisions in the management of the BRCA mutation carrier. J Womens Health (Larchmt) 2013; 22:825-34. [PMID: 23987739 PMCID: PMC4047843 DOI: 10.1089/jwh.2013.4407] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Women afflicted by the hereditary breast and ovarian cancer syndrome face complex decisions regarding medical interventions aimed at reducing their risk of ovarian and breast cancer, interventions which in turn may interfere with their fertility and cause early menopause. This review addresses selected topics of importance and controversy in the management of the BRCA mutation carrier, such as psychological well-being and quality of life, breast and ovarian cancer screening, risk-reducing interventions for breast cancer and ovarian cancer, the issue of hysterectomy at the time of the risk-reducing salpingo-oophorectomy, health consequences of early surgical menopause, and safety of hormonal therapy after oophorectomy. The information presented is based on an extensive review of the literature on the selected topics and on the expertise of our multidisciplinary team.
Collapse
Affiliation(s)
- Daniela L. Stan
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lynne T. Shuster
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Myra J. Wick
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Casey L. Swanson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|