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Zayts O, Shipman H, Fung JL, Liu AP, Kwok S, Tsai AC, Yung T, Chung BH. The different facets of “culture” in genetic counseling: A situated analysis of genetic counseling in Hong Kong. Am J Med Genet 2019; 181:187-195. [DOI: 10.1002/ajmg.c.31699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Olga Zayts
- School of English, Faculty of ArtsThe University of Hong Kong Hong Kong, SAR China
| | - Hannah Shipman
- School of English, Faculty of ArtsThe University of Hong Kong Hong Kong, SAR China
| | - Jasmine L.‐F. Fung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of MedicineThe University of Hong Kong Hong Kong, SAR China
| | - Anthony P.‐Y. Liu
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of MedicineThe University of Hong Kong Hong Kong, SAR China
| | - Sit‐Yee Kwok
- Department of Paediatric CardiologyQueen Mary Hospital, Hong Kong Hong Kong, SAR China
| | - Anne C.‐H. Tsai
- Department of Pediatrics, The Children's HospitalUniversity of Colorado School of Medicine Aurora Colorado
| | - Tak‐Cheung Yung
- Department of Paediatric CardiologyQueen Mary Hospital, Hong Kong Hong Kong, SAR China
| | - Brian H.‐Y. Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of MedicineThe University of Hong Kong Hong Kong, SAR China
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Plaskocinska I, Shipman H, Drummond J, Thompson E, Buchanan V, Newcombe B, Hodgkin C, Barter E, Ridley P, Ng R, Miller S, Dann A, Licence V, Webb H, Tan LT, Daly M, Ayers S, Rufford B, Earl H, Parkinson C, Duncan T, Jimenez-Linan M, Sagoo GS, Abbs S, Hulbert-Williams N, Pharoah P, Crawford R, Brenton JD, Tischkowitz M. New paradigms for BRCA1/BRCA2 testing in women with ovarian cancer: results of the Genetic Testing in Epithelial Ovarian Cancer (GTEOC) study. J Med Genet 2016; 53:655-61. [PMID: 27208206 PMCID: PMC5099175 DOI: 10.1136/jmedgenet-2016-103902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/13/2016] [Accepted: 04/19/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Over recent years genetic testing for germline mutations in BRCA1/BRCA2 has become more readily available because of technological advances and reducing costs. OBJECTIVE To explore the feasibility and acceptability of offering genetic testing to all women recently diagnosed with epithelial ovarian cancer (EOC). METHODS Between 1 July 2013 and 30 June 2015 women newly diagnosed with EOC were recruited through six sites in East Anglia, UK into the Genetic Testing in Epithelial Ovarian Cancer (GTEOC) study. Eligibility was irrespective of patient age and family history of cancer. The psychosocial arm of the study used self-report, psychometrically validated questionnaires (Depression Anxiety and Stress Scale (DASS-21); Impact of Event Scale (IES)) and cost analysis was performed. RESULTS 232 women were recruited and 18 mutations were detected (12 in BRCA1, 6 in BRCA2), giving a mutation yield of 8%, which increased to 12% in unselected women aged <70 years (17/146) but was only 1% in unselected women aged ≥70 years (1/86). IES and DASS-21 scores in response to genetic testing were significantly lower than equivalent scores in response to cancer diagnosis (p<0.001). Correlation tests indicated that although older age is a protective factor against any traumatic impacts of genetic testing, no significant correlation exists between age and distress outcomes. CONCLUSIONS The mutation yield in unselected women diagnosed with EOC from a heterogeneous population with no founder mutations was 8% in all ages and 12% in women under 70. Unselected genetic testing in women with EOC was acceptable to patients and is potentially less resource-intensive than current standard practice.
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Affiliation(s)
- Inga Plaskocinska
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Hannah Shipman
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - James Drummond
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Edward Thompson
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | | | - Barbara Newcombe
- Cambridge Cancer Trials Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Charlotte Hodgkin
- Cambridge Cancer Trials Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Elisa Barter
- Department of Oncology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, Peterborough, UK
| | - Paul Ridley
- Cancer Services, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Rita Ng
- Cancer Services, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Suzanne Miller
- Clinical Cancer Services, Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
| | - Adela Dann
- Cancer Research Team, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Victoria Licence
- Cancer Research Team, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Hayley Webb
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Li Tee Tan
- Clinical Cancer Services, Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
| | - Margaret Daly
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Sarah Ayers
- Department of Oncology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, Peterborough, UK
| | - Barnaby Rufford
- Cancer Services, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Helena Earl
- Department of Oncology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, Cambridgeshire, UK
| | - Christine Parkinson
- Cancer Services, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Timothy Duncan
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Mercedes Jimenez-Linan
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Gurdeep S Sagoo
- PHG Foundation, Cambridge, UK Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Abbs
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Paul Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Robin Crawford
- Cancer Services, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - James D Brenton
- Cancer Services, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK Cancer Research UK Cambridge Institute, Cambridge, Cambridgeshire, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
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Whyte S, Green A, McAllister M, Shipman H. Family Communication in Inherited Cardiovascular Conditions in Ireland. J Genet Couns 2016; 25:1317-1326. [PMID: 27271705 DOI: 10.1007/s10897-016-9974-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/02/2015] [Accepted: 05/16/2016] [Indexed: 12/28/2022]
Abstract
Over 100,000 individuals living in Ireland carry a mutated gene for an inherited cardiac condition (ICC), most of which demonstrate an autosomal dominant pattern of inheritance. First-degree relatives of individuals with these mutations are at a 50 % risk of being a carrier: disclosing genetic information to family members can be complex. This study explored how families living in Ireland communicate genetic information about ICCs and looked at the challenges of communicating information, factors that may affect communication and what influence this had on family relationships. Face to face interviews were conducted with nine participants using an approved topic guide and results analysed using thematic analysis. The participants disclosed that responsibility to future generations, gender, proximity and lack of contact all played a role in family communication. The media was cited as a source of information about genetic information and knowledge of genetic information tended to have a positive effect on families. Results from this study indicate that individuals are willing to inform family members, particularly when there are children and grandchildren at risk, and different strategies are utilised. Furthermore, understanding of genetics is partially regulated not only by their families, but by the way society handles information. Therefore, genetic health professionals should take into account the familial influence on individuals and their decision to attend genetic services, and also that of the media.
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Affiliation(s)
- Sinead Whyte
- Centre for Medical Education, School of Medicine, Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK. .,Institute of Medical Genetics, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Andrew Green
- National Centre for Medical Genetics, Our Lady's Hospital, Crumlin, Dublin 12, Ireland
| | - Marion McAllister
- Centre for Medical Education, School of Medicine, Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK
| | - Hannah Shipman
- Department of Clinical Genetics, Addenbrooke's Hospital NHS Trust, PO Box 134, Cambridge, CB2 0QQ, UK
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Shipman H, Clarke AJ, Sarang S. Accounts of consent: Orienting to self-other relations regarding motivations to participate in cancer bio-banking. Commun Med 2015; 11:69-84. [PMID: 26402965 DOI: 10.1558/cam.v11i1.17324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The motivations of those who give consent to bio-banking research have received a great deal of attention in recent years. Previous work draws upon the notion of altruism, though the self and/or family have been proposed as significant factors. Drawing on 11 interviews with staff responsible for seeking consent to cancer bio-banking and 13 observations of staff asking people to consent in routine clinical encounters, we investigate how potential participants are oriented to, and constructed as oriented to, self and other related concerns (Sarangi 2007). We adopt a rhetorical discourse analytic approach to the data and our perspective can be labelled as 'ethics-in-interaction'. Using analytic concepts such as repetition, extreme case formulation, typical case formulation and contrast structure, our observations are three-fold. Firstly, we demonstrate that orientation to 'general others' in altruistic accounts and to 'self' in minimising burden are foregrounded in constructions of motivation to participate in cancer bio-banking across the data corpus. Secondly, we identify complex relational accounts which involve the self as being more prominent in the consent encounter data where the staff have a nursing background, whereas 'general others' feature more when the staff have a scientific background. Finally, we suggest implications based on the disparities between how participants are oriented during interviews and consent encounters, which may have relevance for developing professional reflective practice.
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