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Sanchez G, Hashmi SS, Bednar E, Horvath S, Kumar B, Sagaser K, Singletary CN, Ramdaney A. Status of abortion curriculum in genetic counseling: Survey of graduate programs and recent graduates in the United States. J Genet Couns 2024. [PMID: 38410885 DOI: 10.1002/jgc4.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
Genetic counselors (GCs) are trained to help individuals navigate the medical and psychological implications of genetic test results, familial conditions, and ultrasound anomalies. Therefore, familiarity with reproductive options, including abortion, is vital. However, previous studies have found gaps in GCs' knowledge regarding abortion care and there are currently no recommendations regarding abortion curriculum. This study aimed to assess the state of abortion curriculum in genetic counseling graduate programs in the United States and to examine and compare the satisfaction levels of program representatives and recent graduates. Program representatives and recent graduates were invited to complete an anonymous survey evaluating the abortion curriculum, satisfaction with said curriculum, and perceived preparedness to counsel on abortion. Quantitative data from 46 program representatives and 123 recent graduates were analyzed using descriptive statistics and appropriate statistical analyses, including the Mann-Whitney U-test and the Kruskal-Wallis test. Large variability existed in the amount and types of abortion training. Results showed greater satisfaction and feelings of preparation to counsel on abortion in graduates whose program provided a dedicated abortion curriculum (p < 0.001, p = 0.005). In addition, graduates with abortion counseling experience felt less prepared to counsel on abortion than their programs believed them to be (p = 0.04). Graduates perceived procedural timing, facilitation of genetic testing, and resources/support desired by patients before, during, or after an abortion, to be the most important topics, although these were not included in all programs' curriculum. Program representatives and recent graduates alike noted that variability in clinical training is a barrier to abortion education. Our results demonstrate a need for curricular reform to reduce variability in training and ensure that all graduates receive the same foundational abortion education. Further research is needed to determine the scope of GCs in abortion care, as well as which topics and education formats are most helpful in graduate education.
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Affiliation(s)
- Gina Sanchez
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
| | - S Shahrukh Hashmi
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Erica Bednar
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Gynecologic Oncology Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Horvath
- Department of Obstetrics and Gynecology Division of Women's Health at Penn State, Hershey, Pennsylvania, USA
| | - Bhavik Kumar
- Planned Parenthood Gulf Coast, Houston, Texas, USA
| | | | - Claire N Singletary
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Aarti Ramdaney
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
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2
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Amos K, McCarthy Veach P, Wagner C, Czerwinski J, Murphy L, Mork M, Singletary CN. Influence of genetic counselor medical history on specialty and psychosocial practice in North America. J Genet Couns 2021; 31:663-676. [PMID: 34826351 DOI: 10.1002/jgc4.1533] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/07/2022]
Abstract
A personal or family medical history is inherently part of a genetic counselor's life story. Yet, the degree to which this history influences counselors' clinical specialty choice and professional psychosocial practice is unexplored. A medical diagnosis may foster capacity for greater empathy, understanding, and rapport-building self-disclosure. Conversely, it could lead to disruptive countertransference, compassion fatigue, and eventually burnout. Research, however, has not specifically investigated this intersection. The aim of this study was to explore the impact of genetic counselors' personal and/or family medical history on choice of practice area and self-perceived impact on their psychosocial work within sessions. Members of the National Society of Genetic Counselors were recruited to complete an online screening survey. Of the 69 survey respondents that met inclusion criteria, 23 volunteered for and completed a telephone interview. Interview questions explored counselors' medical narratives and their consequent influence on specialty choice and clinical interaction with patients. Inductive analysis yielded nine domains within three major themes: Medical Story, Specialty Impact, and Psychosocial Influence. Participants were more likely to be attracted to a specialty possessing overlap with their medical history and attributed many of their psychosocial strengths to personal and/or family medical experiences, such as increased empathy or a more expansive scope in how they cared for patients. Many counselors, however, noted their medical history did not frequently influence their clinical practice, with most initially denying or downplaying use of self-disclosure about their history. Contradictory to their statements, the majority gave at least one example of self-disclosure, whether indirect, prompted, or direct. Importantly, almost all participants named or demonstrated countertransference. This study highlights that while medical history can be a valuable asset in providing care for patients, it requires a genetic counselor's diligent attentiveness and commitment to honest self-reflection.
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Affiliation(s)
- Kaitlyn Amos
- Duke Adult Cardiovascular Genetics Clinic, Durham, North Carolina, USA.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | | | - Chelsea Wagner
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,McGovern Medical School at UTHealth, Houston, Texas, USA.,Gene Matters LLC, San Francisco, California, USA
| | - Jennifer Czerwinski
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Lauren Murphy
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,McGovern Medical School at UTHealth, Houston, Texas, USA.,Invitae Corporation, San Francisco, California, USA
| | - Maureen Mork
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claire N Singletary
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,McGovern Medical School at UTHealth, Houston, Texas, USA
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Wagner C, Stein Q, Singletary CN. Genesurance counseling: Current training practices of genetic counseling graduate programs in the United States. J Genet Couns 2021; 30:1757-1766. [PMID: 34265129 DOI: 10.1002/jgc4.1444] [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: 03/10/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/06/2022]
Abstract
In recent years, it has become apparent that patients expect genetic counselors to be able to address questions about insurance coverage for genetic testing and perform 'genesurance' tasks in and out of genetic counseling sessions. Anecdotally, many genetic counseling graduate programs have begun to incorporate genesurance training in some capacity. However, the amount, modality, and potential barriers to this training had not been previously studied; therefore, this study aimed to elucidate current graduate program practice regarding genesurance. Program Directors of Accreditation Council for Genetic Counseling (ACGC) accredited programs who had students enrolled as of July 2019 (n = 50) were recruited through the Association of Genetic Counseling Program Directors (AGCPD) listserv and invited to complete an anonymous electronic survey via Qualtrics. Program Directors (PDs) from 25 ACGC accredited programs located in the United States completed the survey and were included in the analysis, responses from two ACGC Canadian programs were excluded due to small sample size and differences in healthcare systems. Responses were analyzed using descriptive statistics and open-ended responses were coded utilizing latent qualitative content analysis. The majority of respondents from the United States, 96.0% (24/25), report incorporating genesurance training into their curriculum utilizing a variety of training modalities including classroom, clinical, and online experiences. Most (81.0%) felt their trainees were adequately or very prepared to discuss genesurance issues. Despite varied methods of teaching modalities, PDs identified barriers to providing this training, including time constraints within the curriculum, lack of interest in the subject, as well as acknowledging the constantly changing landscape of billing and insurance. Despite these barriers, a baseline understanding of the impact of insurance on offering genetic testing and insight into how insurance impacts clinical practice may be beneficial to genetic counseling trainees, as it reflects the current genetic counselor's workflow and practice patterns.
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Affiliation(s)
- Chelsea Wagner
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,University of Texas Genetic Counseling Program, University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Quinn Stein
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD, USA
| | - Claire N Singletary
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,University of Texas Genetic Counseling Program, University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Ashfaq M, Moats AR, Northrup H, Singletary CN, Hashmi SS, Koenig MK, Bagg MB, Rodriguez-Buritica D. Hypoglycemia in mitochondrial disorders. Mitochondrion 2021; 58:179-183. [PMID: 33737013 DOI: 10.1016/j.mito.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/23/2020] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
Diabetes and hyperglycemia are common features of mitochondrial disorders. This study investigates the frequency of non-iatrogenic hypoglycemia in individuals with these disorders. Of 116 patients, 22 (18.97%) experienced at least two episodes of hypoglycemia. This rate is significantly higher (p < 0.05) than the 6% seen in the non-diabetic, general population. Neonatal readings were 30 mg/dL lower than non-neonatal readings. As hypoglycemia appears to occur frequently in individuals with mitochondrial disorders, with lower blood glucose levels in the neonatal period, early and continued monitoring of blood glucose is necessary. Also, mitochondrial disorders should be considered in cases of recurrent hypoglycemia.
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Affiliation(s)
- Myla Ashfaq
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Allison R Moats
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Hope Northrup
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Claire N Singletary
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S Shahrukh Hashmi
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Pediatrics, Pediatric Research Center, McGovern Medical School at The University of Texas Health Center at Houston, Houston, TX, USA
| | - Mary Kay Koenig
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pediatrics, Division of Child and Adolescent Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael B Bagg
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Rodriguez-Buritica
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
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5
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Nunley PB, Hashmi SS, Johnson A, Ashfaq M, Farach LS, Singletary CN, Stevens BK. Exploring the predicted yield of prenatal testing by evaluating a postnatal population with structural abnormalities using a novel mathematical model. Prenat Diagn 2020; 41:354-361. [PMID: 33128384 DOI: 10.1002/pd.5858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/29/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the yield of prenatal testing and screening options after identification of fetal structural abnormalities using a novel mathematical model. METHOD A retrospective chart review was conducted to collect structural abnormality and genetic testing data on infants who were evaluated postnatally by a medical geneticist. A novel mathematical model was used to determine and compare the predicted diagnostic yields of prenatal testing and screening options. RESULTS Over a quarter of patients with at least one structural abnormality (28.1%, n = 222) had a genetic aberration identified that explained their phenotype. Chromosomal microarray (CMA) had the highest predicted diagnostic yield (26.8%, P < .001). Karyotype (20.8%) had similar yields as genome wide NIPT (21.2%, P = .859) and NIPT with select copy number variants (CNVs) (17.9%, P = .184). Among individuals with an isolated structural abnormality, whole exome sequencing (25.9%) and CMA (14.9%) had the highest predicted yields. CONCLUSION This study introduces a novel mathematical model for predicting the potential yield of prenatal testing and screening options. This study provides further evidence that CMA has the highest predicted diagnostic yield in cases with structural abnormalities. Screening with expanded NIPT options shows potential for patients who decline invasive testing, but only in the setting of adequate pre-test counseling.
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Affiliation(s)
- Peyton B Nunley
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Syed S Hashmi
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Anthony Johnson
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Myla Ashfaq
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura S Farach
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Claire N Singletary
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Blair K Stevens
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
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6
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Giles Choates M, Stevens BK, Wagner C, Murphy L, Singletary CN, Wittman AT. It takes two: uptake of carrier screening among male reproductive partners. Prenat Diagn 2019; 40:311-316. [PMID: 31793013 DOI: 10.1002/pd.5588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe uptake of carrier screening by male reproductive partners of prenatal and preconception patients. METHODS A retrospective database review of all prenatal and preconception patients seen for genetic counseling in Maternal Fetal Medicine clinics was performed. Descriptive statistics and chi-square analysis were used on the data set. RESULTS Within the study period, 6087 patients were seen for genetic counseling, of whom 661 were identified as a carrier of an autosomal recessive disorder by their referring provider or genetic counselor. Despite guidelines recommending partner testing for risk clarification when a woman is known to be a carrier of an autosomal recessive condition, only 41.5% male partners elected carrier screening to clarify the couple's reproductive risk, with a majority of males (75%) having screening consecutively. Of all assessed variables, the only significant predictors of male carrier screening uptake were female parity and earlier gestational age (p < .0001, and p = .001, respectively). CONCLUSION With less than half of male partners pursuing carrier screening when indicated, its utility becomes severely diminished. More research is needed to explore reasons why males elect or decline carrier screening.
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Affiliation(s)
- Meagan Giles Choates
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Blair K Stevens
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Chelsea Wagner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Lauren Murphy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Claire N Singletary
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A Theresa Wittman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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Singletary CN, Krstic NC, Czerwinski JL, Choates MG, Wagner C. Prenatal chromosomal microarray uptake with invasive prenatal diagnosis: How many patients take the leap? Prenat Diagn 2018; 38:748-754. [DOI: 10.1002/pd.5324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Claire N. Singletary
- Department of Obstetrics, Gynecology and Reproductive Sciences; McGovern Medical School at the University of Texas Health Science Center at Houston; Houston Texas
- Department of Pediatrics; McGovern Medical School at the University of Texas Health Science Center at Houston; Houston Texas
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences; Houston Texas
| | - Nevena Cvjetkovic Krstic
- Department of Obstetrics and Gynecology, Morsani College of Medicine; University of South Florida; Tampa Florida
| | - Jennifer L. Czerwinski
- Department of Obstetrics, Gynecology and Reproductive Sciences; McGovern Medical School at the University of Texas Health Science Center at Houston; Houston Texas
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences; Houston Texas
| | - Meagan Giles Choates
- Department of Obstetrics, Gynecology and Reproductive Sciences; McGovern Medical School at the University of Texas Health Science Center at Houston; Houston Texas
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences; Houston Texas
| | - Chelsea Wagner
- Department of Obstetrics, Gynecology and Reproductive Sciences; McGovern Medical School at the University of Texas Health Science Center at Houston; Houston Texas
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences; Houston Texas
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Reese KM, Czerwinski J, Darilek S, Johnson A, Jones M, Singletary CN. Attitudes Toward and Uptake of Prenatal Genetic Screening and Testing in Twin Pregnancies. J Genet Couns 2018. [DOI: 10.1007/s10897-018-0246-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berg J, Hoskovec J, Hashmi SS, McCarthy Veach P, Ownby A, Singletary CN. Relieving the Bottleneck: An Investigation of Barriers to Expansion of Supervision Networks at Genetic Counseling Training Programs. J Genet Couns 2017; 27:241-251. [DOI: 10.1007/s10897-017-0142-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
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Abstract
Objective To determine patient perception of residual risk after receiving a negative non-invasive prenatal testing result. Introduction Recent technological advances have yielded a new method of prenatal screening, non-invasive prenatal testing (NIPT), which uses cell-free fetal DNA from the mother's blood to assess for aneuploidy. NIPT has much higher detection rates and positive predictive values than previous methods however, NIPT is not diagnostic. Past studies have demonstrated that patients may underestimate the limitations of prenatal screening; however, patient perception of NIPT has not yet been assessed. Methods and Materials We conducted a prospective cohort study to assess patient understanding of the residual risk for aneuploidy after receiving a negative NIPT result. Ninety-four participants who had prenatal genetic counseling and a subsequent negative NIPT were surveyed. Results There was a significant decline in general level of worry after a negative NIPT result (p = <0.0001). The majority of participants (61%) understood the residual risk post NIPT. Individuals with at least four years of college education were more likely to understand that NIPT does not eliminate the chance of trisomy 13/18 (p = 0.012) and sex chromosome abnormality (p = 0.039), and were more likely to understand which conditions NIPT tests for (p = 0.021), compared to those women with less formal education. Conclusion These data demonstrate that despite the relatively recent implementation of NIPT into obstetric practice, the majority of women are aware of its limitations after receiving genetic counseling. However, clinicians may need to consider alternative ways to communicate the limitations of NIPT to those women with less formal education to ensure understanding.
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Affiliation(s)
- A Theresa Wittman
- Genetic Counseling Program, University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, Texas
| | - S Shahrukh Hashmi
- Genetic Counseling Program, University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Pediatrics, McGovern Medical School at UT Health, Houston, Texas
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health, Houston, Texas
| | - Salma Nassef
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, Texas
| | - Blair Stevens
- Genetic Counseling Program, University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health, Houston, Texas
| | - Claire N Singletary
- Genetic Counseling Program, University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Pediatrics, McGovern Medical School at UT Health, Houston, Texas; Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health, Houston, Texas
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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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Mitri ZI, Jackson M, Garby C, Song J, Giordano SH, Hortobágyi GN, Singletary CN, Hashmi SS, Arun BK, Litton JK. BRCAPRO 6.0 Model Validation in Male Patients Presenting for BRCA Testing. Oncologist 2015; 20:593-7. [PMID: 25948675 DOI: 10.1634/theoncologist.2014-0425] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND BRCAPRO is a risk assessment model to estimate the risk of carrying a BRCA mutation. BRCA mutation carriers are at higher risk of developing breast, ovarian, pancreatic, and prostate cancer. BRCAPRO was developed for women and found to be superior to other risk assessment models. The present study evaluated the validity of BRCAPRO at predicting the risk of male patients carrying a BRCA mutation. PATIENTS AND METHODS A total of 146 men who presented for genetic counseling and testing from February1997 to September 2011, and their test results were included in the present study. BRCAPRO risk assessment for all patients was calculated using the BRCAPRO clinical CancerGene assessment software. RESULTS The mean age at presentation was 57 years. Of the 146 patients, 48 had breast cancer, 18 had pancreatic cancer, 39 had prostate cancer, 27 had other primary cancers, and 37 had no cancer. Fifty patients (34%) tested positive for a BRCA mutation (22 BRCA1, 27 BRCA2, and 1 BRCA1 and BRCA2). The mean BRCAPRO score for all patients was 24.96%. The BRCAPRO score was significantly higher for patients who tested positive for a BRCA mutation (46.19% vs. 13.9%, p < .01). The area under the receiver operating characteristics curve was 0.83 for all patients for the BRCAPRO score to predict the risk of carrying a BRCA mutation. At a cutoff point of 30.02%, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.74, 0.81, 0.67, and 0.86, respectively. CONCLUSION BRCAPRO appears to be a valid risk assessment tool for determining the risk of carrying a BRCA mutation in men. IMPLICATIONS FOR PRACTICE Men carrying genetic mutations in the BRCA gene have a greater risk than the general population of developing certain types of cancer, including breast, pancreatic, and prostate cancer. BRCAPRO is a risk assessment model that predicts the risk of carrying a BRCA mutation. The present study aimed at validating BRCAPRO for use with men seen for genetic counseling, whether affected by cancer or not. The data available for 146 patients revealed that BRCAPRO was effective at identifying patients at risk of BRCA mutation. These findings could help in identifying a subset of high-risk patients who should proceed to genetic testing.
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Affiliation(s)
- Zahi I Mitri
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Michelle Jackson
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Carolyn Garby
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Juhee Song
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Sharon H Giordano
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Gabriel N Hortobágyi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Claire N Singletary
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - S Shahrukh Hashmi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Banu K Arun
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Jennifer K Litton
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
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Abstract
OBJECTIVE Noninvasive prenatal testing (NIPT) via cell-free fetal DNA in the maternal circulation is a highly sensitive and specific new testing option. The objective of this study was to determine the impact of NIPT on the uptake of first trimester screening (FTS) and invasive genetic testing. STUDY DESIGN Uptake of prenatal testing was investigated in women referred for advanced maternal age or abnormal screening to the University of Texas Health Maternal-Fetal Medicine Clinics in Houston. Patients who presented from August to November 2011, before clinical introduction of NIPT, were compared with patients who presented from March to June 2012, after its introduction. RESULTS In patients referred between 14 and 22 weeks gestational age, invasive genetic testing was significantly reduced following the introduction of NIPT (35.4 vs. 17.9%, p < 0.05). For patients referred at < 14 weeks gestational age, FTS was significantly reduced with NIPT introduction (89.1 vs. 59.1%, p < 0.05); however, invasive genetic testing was not significantly different (20.0 vs. 14.0%, p > 0.05). CONCLUSION NIPT has made an impact on the practice of maternal-fetal medicine by significantly decreasing the number of second trimester diagnostic tests performed. In addition, patients interested in early screening information appear to prefer the higher sensitivity and specificity of NIPT.
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Affiliation(s)
- Lara A Friel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jennifer L Czerwinski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Claire N Singletary
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Pediatrics, The University of Health Science Center at Houston, Houston, Texas
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Nuccio R, Hashmi SS, Mastrobattista J, Noblin SJ, Refuerzo J, Smith JL, Singletary CN. Influence of Anchoring on Miscarriage Risk Perception Associated with Amniocentesis. J Genet Couns 2014; 24:278-84. [DOI: 10.1007/s10897-014-9761-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
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