Genomic sequencing research in pediatric cancer care: Decision-making, attitudes, and perceived utility among adolescents and young adults and their parents

PURPOSE

Professional guidelines recommend engaging adolescents and young adults (AYAs) in medical decision-making (DM), including whether to undergo genomic sequencing (GS). We explored DM around GS and attitudes after return of GS results among a diverse group of AYAs with cancer and their parents.

METHODS

We surveyed AYAs with cancer (n=75) and their parents (n=52) six months after receiving GS results through the Texas KidsCanSeq Study. We analyzed AYAs' DM role in GS research enrollment and their satisfaction with that role. We compared AYAs' and parents' self-reported understanding of, attitudes toward, and perceived utility of the AYAs' GS results.

RESULTS

Most AYAs reported equally sharing DM with their parents (55%) or leading DM (36%) about GS research. Compared to their cancer care DM role, 56% of AYAs reported the same level of involvement in GS research DM while 32% were more involved and 13% were less involved (p=0.011). AYAs were satisfied (99%) with their DM role regarding GS study participation. AYAs and parents had similar self-reported understanding of, attitudes toward, and perceived utility of the GS results.

CONCLUSION

Our results support engaging AYAs in DM about GS research and provide insights into AYAs' DM preferences and positive attitudes toward GS.

Perceived utility and disutility of genomic sequencing for pediatric patients: Perspectives from parents with diverse sociodemographic characteristics

Given the limited therapeutic options for most rare diseases diagnosed through genomic sequencing (GS) and the proportion of patients who remain undiagnosed even after GS, it is important to characterize a broader range of benefits and potential harms of GS from the perspectives of families with diverse sociodemographic characteristics. We recruited parents of children enrolled in the Undiagnosed Diseases Network. Parents completed an in-depth interview, and we conducted a comparative content analysis of the data. Parents (n = 30) were demographically diverse, with 43.3% identifying as Hispanic, 33.3% primarily Spanish-speaking, and widely variable household income and education. Parents reported minimal changes in their child's health status following GS but did report a range of other forms of perceived utility, including improvements in their child's healthcare management and access, in their own psychological well-being, and in disease-specific social connections and research opportunities. Parents who received a diagnosis more frequently perceived utility across all domains; however, disutility also was reported by both those with and without a diagnosis. Impacts depended on multiple mediating factors, including parents' underlying expectations and beliefs, family sociodemographic characteristics, individual disease characteristics, and prior healthcare access. Our study suggests that the perceived utility of GS varies widely among parents and may depend on multiple individual, sociodemographic, and contextual factors that are relevant for pre- and post-GS counseling, for value assessment of GS, and for policymaking related to access to new genomic technologies.

Students' Attitudes Toward Online Music Education During the COVID 19 Lockdown

Given the current pandemic context generated by COVID 19, important changes in the way specific subjects to music education are taught emerged, affecting not only the particularities of learning and teaching in individual courses, but also the other courses regarding group learning or theoretical subjects. In this time, emergency remote teaching and learning requires cross-collaboration between instructional, content, and technological teams. Our research examines the students' attitudes toward online education, also presenting proposals for optimization and efficiency. The research was undertaken after an experience of a University semester in a lockdown context, and it aimed at undergraduate and master's degree students from music faculties in Romania. An important result was the mediating role of perceived utility of e-learning methods, perceived utility mediated the associations between compatibility of online methods and satisfaction toward the use of e-learning methods. The perceived compatibility of e-Learning methods with online music education led to a higher perceived utility which, in turn, predicted a higher satisfaction toward e-Learning Although this period accentuated the fear of interaction with others, the anxiety related to the unknown, the intolerance of uncertainty did not predict the satisfaction toward the use of e-learning platforms. In conclusion, more educational initiatives are needed to promote remote teaching methods in music education. In the absence of similar research in our country, we considered that future research on this topic is needed.

Should I Stay, or Should I Go? Job satisfaction as a moderating factor between outcome expectations and entrepreneurial intention among academics

Both psychological and entrepreneurship research have highlighted the pivotal role of job satisfaction in the process of entrepreneurial career decisions. In support of this, mounting evidence point to inter-relationships between entrepreneurial intention, job satisfaction, and organizational commitment. Prior research operationalized entrepreneurial careers as an escape from poor work environments; thus, there is a lack of understanding regarding how job-satisfaction can trigger entrepreneurship within and related to the environment of universities. This study, draws on Social Cognitive Career Theory and the concept of entrepreneurial intention, to address whether the role of job satisfaction is a moderating factor between outcome expectations and entrepreneurial intention. Furthermore, we examine to what extent (I) entrepreneurial intention and (II) spin-off intention are determined by certain outcome expectations and perceived behavioral control. To address these questions this study examined academic researchers in specialized and non-technical fields and builds on a survey of 593 academic researchers at Swiss Universities of Applied Science. The results showed that outcome expectations are a significant predictor for entrepreneurial intentions, in general, and spin-off intentions, in particular. A multi-group analysis corroborated that job satisfaction operates as a motivational factor in entrepreneurial transition and interactions with entrepreneurial outcome expectations. In conclusion, the concept of job satisfaction and Social Cognitive Career Theory were powerful constructs to better the understand the process of entrepreneurial career decisions by academic researchers.

A Prospective Study of Parental Perceptions of Rapid Whole-Genome and -Exome Sequencing among Seriously Ill Infants

Rapid diagnostic genomic sequencing recently became feasible for infants in intensive care units (ICUs). However, research regarding parents' perceived utility, adequacy of consent, and potential harms and benefits is lacking. Herein we report results of parental surveys of these domains from the second Newborn Sequencing in Genomic Medicine and Public Health (NSIGHT2) study, a randomized, controlled trial of rapid diagnostic genomic sequencing of infants in regional ICUs. More than 90% of parents reported feeling adequately informed to consent to diagnostic genomic sequencing. Despite only 23% (27) of 117 infants receiving genomic diagnoses, 97% (156) of 161 parents reported that testing was at least somewhat useful and 50.3% (88/161) reported no decisional regret (median 0, mean 10, range 0-100). Five of 117 families (4.3%) reported harm. Upon follow-up, one (1%) confirmed harm to child and parent related to negative results/no diagnosis, two (2%) reported stress or confusion, and two (2%) denied harm. In 81% (89) of 111 infants, families and clinicians agreed that genomic results were useful. Of the families for whom clinicians perceived harm from genomic testing, no parents reported harm. Positive tests/genomic diagnosis were more frequently perceived to be useful by parents, to benefit their infant, and to help manage potential symptoms (p < .05). In summary, the large majority of parents felt that first-tier, rapid, diagnostic genomic sequencing was beneficial for infants lacking etiologic diagnoses in ICUs. Most parents in this study perceived being adequately informed to consent, understood their child's results, and denied regret or harm from undergoing sequencing.

Comprehension and personal value of negative non-diagnostic genetic panel testing

Increasing interest and pursuit of genetic testing by the general public have raised concerns about their understanding and use of their results. While most research has focused on individuals receiving positive genetic test results, there have been limited investigations assessing the understanding and utility of receiving negative genetic test results. Individuals who receive a negative (or uninformative) genetic test result may not appreciate the limitations of genetic testing and their residual disease risk. The goals of this study were to explore participant understanding and perceived utility of negative non-diagnostic genetic test results. We conducted semi-structured interviews with participants who received negative non-diagnostic genetic test results from the electronic Medical Records and Genomics Network (eMERGE) testing panel at Northwestern University. A total of 17 participants were interviewed. While many expressed a lack of understanding of genetics and the relationship between genes, disease, and environment, most acknowledged that they had residual risk to develop a health problem and should continue with their routine health management. Additionally, participants expressed that their negative results had personal value, by providing them peace of mind and learning additional knowledge about themselves and their health. Participants did not anticipate that results would have an impact on their lifestyle, but felt the results were useful for sharing with their physician and could inform future genetic testing decisions. While mostly positive, some participants were disappointed not to learn more individualized results. While a more thorough exploration is necessary, findings in this study can aid efforts to improve or innovate informed consent for genomic testing, as well as scalable modes of result return that foster comprehension following negative genetic testing.

Factors Influencing Prescribing Perceived Utility of Drugs: Experiences from Iraqi Kurdistan

Introduction:

Pharmaceutical expenditures have increased dramatically in most developed and developing countries in recent decades. Healthcare system policymakers have expressed concerns about the inappropriate, irrational, or harmful prescribing of drugs.

Objectives:

The attitudes of physicians towards prescribing generic drugs and predictors of perceived utility of drugs were investigated in the present study.

Methods:

In this cross-sectional research, 77 physicians at different levels of job hierarchies, working in various public sector shifts, were recruited to participate in a survey of their attitudes toward prescribing generic drugs in Iraqi Kurdistan in 2018. The doctors were located in a general, an emergency, and a pediatric hospital. A self-administered structured questionnaire was designed based on the extended technology acceptance model for product use (TETPU).

Results:

The doctors agreed that drugs should be prescribed according to their utility for patients (median [M] = 5.0; interquartile range [IQR] = 2.9). Most of the physicians mentioned that they prescribed drugs according to the patients’ needs (75.0%), evaluation of the availability of alternatives (69.0%) and consumer perceptions of a price (69.0%). The analysis showed that (1) the importance of physicians’ perceptions and their recognition of patients’ need achievement (P=.012), (2) the physicians' recognition of the actual use of drugs by consumers (P=.030) and (3) being male (p=.009) were associated with perceptions of drug utility.

Conclusions:

The study’s results suggest that perceived drug utility in prescription writing is associated with physicians’ perceptions of need achievement and attitudes toward how patients actually use medicines.

Individual Precursors of Student Homework Behavioral Engagement: The Role of Intrinsic Motivation, Perceived Homework Utility and Homework Attitude

Currently, the concept of engagement is crucial in the field of learning and school achievement. It is a multidimensional concept (e.g., behavioral, emotional, and cognitive dimensions) that has been widely used as a theoretical framework to explain the processes of school engagement and dropout. However, this conceptual framework has been scarcely used in the field of homework. The aim of the present study was to analyze the role of intrinsic motivation, perceived homework utility, and personal homework attitude as precursors of student homework engagement (behavioral engagement) and, at the same time, how such engagement is the precursor of academic achievement. Seven hundred and thirty students of Compulsory Secondary Education (CSE) (7th to 10th grade) from fourteen schools northern Spain participated. A structural equation model was elaborated on which intrinsic motivation, perceived utility and attitude were observed variables, and student engagement (time spent on homework, time management, and amount of teacher-assigned homework done) and academic achievement (Mathematics, Spanish Language, English Language, and Social Science) were latent variables. The results reveal that (i) intrinsic motivation is a powerful precursor of student behavioral engagement (also perceived utility and attitude, although to a lesser extent), and (ii) academic achievement is closely linked to the level of student engagement, qualifying the results of many of the previous studies conducted from a task-centered perspective (as opposed to a person-centered perspective).

Much ado about nothing: A qualitative study of the experiences of an average-risk population receiving results of exome sequencing

The increasing availability of exome sequencing to the general ("healthy") population raises questions about the implications of genomic testing for individuals without suspected Mendelian diseases. Little is known about this population's motivations for undergoing exome sequencing, their expectations, reactions, and perceptions of utility. In order to address these questions, we conducted in-depth semi-structured interviews with 12 participants recruited from a longitudinal multi-omics profiling study that included exome sequencing. Participants were interviewed after receiving exome results, which included Mendelian disease-associated pathogenic and likely pathogenic variants, pharmacogenetic variants, and risk assessments for multifactorial diseases such as type 2 diabetes. The primary motivation driving participation in exome sequencing was personal curiosity. While they reported feeling validation and relief, participants were frequently underwhelmed by the results and described having expected more from exome sequencing. All participants reported discussing the results with at least some family, friends, and healthcare providers. Participants' recollection of the results returned to them was sometimes incorrect or incomplete, in many cases aligning with their perceptions of their health risks when entering the study. These results underscore the need for different genetic counseling approaches for generally healthy patients undergoing exome sequencing, in particular the need to provide anticipatory guidance to moderate participants' expectations. They also provide a preview of potential challenges clinicians may face as genomic sequencing continues to scale-up in the general population despite a lack of full understanding of its impact.

The Exercise-Affect-Adherence Pathway: An Evolutionary Perspective

The low rates of regular exercise and overall physical activity (PA) in the general population represent a significant public health challenge. Previous research suggests that, for many people, exercise leads to a negative affective response and, in turn, reduced likelihood of future exercise. The purpose of this paper is to examine this exercise-affect-adherence relationship from an evolutionary perspective. Specifically, we argue that low rates of physical exercise in the general population are a function of the evolved human tendency to avoid unnecessary physical exertion. This innate tendency evolved because it allowed our evolutionary ancestors to conserve energy for physical activities that had immediate adaptive utility such as pursuing prey, escaping predators, and engaging in social and reproductive behaviors. The commonly observed negative affective response to exercise is an evolved proximate psychological mechanism through which humans avoid unnecessary energy expenditure. The fact that the human tendencies toward negative affective response to and avoidance of unnecessary physical activities are innate does not mean that they are unchangeable. Indeed, it is only because of human-engineered changes in our environmental conditions (i.e., it is no longer necessary for us to work for our food) that our predisposition to avoid unnecessary physical exertion has become a liability. Thus, it is well within our capabilities to reengineer our environments to once again make PA necessary or, at least, to serve an immediate functional purpose. We propose a two-pronged approach to PA promotion based on this evolutionary functional perspective: first, to promote exercise and other physical activities that are perceived to have an immediate purpose, and second, to instill greater perceived purpose for a wider range of physical activities. We posit that these strategies are more likely to result in more positive (or less negative) affective responses to exercise, better adherence to exercise programs, and higher rates of overall PA.

Patients' perceived utility of whole-genome sequencing for their healthcare: findings from the MedSeq project

AIM

To evaluate patients' expectations regarding the perceived utility of whole-genome sequencing (WGS).

MATERIALS & METHODS

We used latent class analysis to characterize individuals enrolled in the MedSeq Project based on their perceived utility of WGS. Multinomial logistic regression was used to evaluate associations between participant characteristics and latent classes.

RESULTS

Findings characterized participants into one of three perceived utility groups: enthusiasts, who had a high probability of agreement with all utility items (23%); health conscious, who perceived utility in medically related areas (60%) or skeptics, who had a low probability of agreement with utility items (17%). Trust significantly predicted latent class.

CONCLUSION

Understanding differences in perceived utility of WGS may inform strategies for uptake of this technology.