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Roca M, Martin-Santos R, Saiz J, Obiols J, Serrano MJ, Torrens M, Subirà S, Gili M, Navinés R, Ibañez A, Nadal M, Barrantes N, Cañellas F. Diagnostic Interview for Genetic Studies (DIGS): Inter-rater and test-retest reliability and validity in a Spanish population. Eur Psychiatry 2020; 22:44-8. [PMID: 17188842 DOI: 10.1016/j.eurpsy.2006.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 10/13/2006] [Accepted: 10/19/2006] [Indexed: 11/18/2022] Open
Abstract
AbstractObjectiveTo test the reliability and validity of the DIGS in Spanish population.MethodsInter-rater and test-retest reliability of the Spanish version of DIGS was tested in 95 inpatients and outpatients. The resultant diagnoses were compared with diagnoses obtained by the LEAD (Longitudinal Expert All Data) procedure as “gold standard”. The kappa statistic was used to measure concordance between blind inter-raters and between the diagnoses obtained by LEAD procedure and through the DIGS.ResultsOverall kappa coefficient for inter-rater reliability was 0.956. The kappa value for individual diagnosis varied from major depression = 0.877 to schizophrenia = 1. Test-retest reliability was 0.926. Kappa for all individual target diagnoses ranged from 0.776 (major depression) to 1. Kappa between LEAD procedure and DIGS ranged from 0.704 (major depression) to 0.825 (bipolar I disorder).ConclusionMost of the DSM-IV major psychiatric disorders can be assessed with acceptable to excellent reliability with the Spanish version of the DIGS interview. The Spanish version of DIGS showed an acceptable to excellent concurrent validity. Giving the good reliability and validity of Spanish version of DIGS it should be considered to identify psychiatric phenotypes for genetics studies.
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Affiliation(s)
- Miguel Roca
- Hospital Joan March, University of Balearic Islands, Institut Universitari d'Investigació en Ciències de la Salut, Edifici Guillem Cifre, Carretera de Valldemossa km 7,5, 07122 Palma de Mallorca, Baleares, Spain.
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Abstract
SummaryWe investigated the psychological impact of testing for the presence of thrombophilic alterations. The enrolled subjects received counseling from a physician before blood sampling and after receiving results, with a view to provide clear information about the aim of thrombophilia screening (TS). Participants were requested to completea pre-test questionnaire during this interview and a post-test questionnaire 20 days after receiving theTS results. One hundred ninety-seven subjects completed the pre-test questionnaire and 140/197 (71.1%) returned the post-test one. The TS results were altered in 36 (25.7%, R506Q mutation n=19; G20210A mutation n=9; antithrombin deficiency n=1; LAC phenomenon n=4; hyperhomocysteinemia n=3) and normal in 104 subjects. We assessed: perceived health status (PHS), state of anxiety, health fears, depressive reactions, moods, perceived well-being, and perceived daily-life stress. For both groups, both at pre- and post-test, none of the psychological variable scores showed significant worsening, regardless of whether TS resulted altered or normal. Anxiety significantly (p≤0.05) decreased at post-test in the altered group and a nonsignificant improvement in PHS after TS result communication was recorded in both groups. Age was an important factor in mediating psychological impact. In conclusion, diagnosis of thrombophilic alterations seems to be well accepted in the short term and TS should not be discouraged for potential adverse psychological effects. However, the psychological impact over a longer period of receiving altered results needs to be further investigated. The relationship between absence of adverse psychological reactions and quality of counseling program provided before and after TS should also be investigated.
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Affiliation(s)
- Cristina Legnani
- Department of Angiology and Blood Coagulation Marino Golinelli, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Abstract
This study aimed to determine the extent to which the principles of privacy and equality were observed during diagnostic genetic testing according to views held by patients or child patients' parents (n = 106) and by staff (n = 162) from three Finnish university hospitals. The data were collected through a structured questionnaire and analysed using the SAS 8.1 statistical software. In general, the two principles were observed relatively satisfactorily in clinical practice. According to patients/parents, equality in the post-analytic phase and, according to staff, privacy in the pre-analytic phase, involved the greatest ethical problems. The two groups differed in their views concerning pre-analytic privacy. Although there were no major problems regarding the two principles, the differences between the testing phases require further clarification. To enhance privacy protection and equality, professionals need to be given more genetics/ethics training, and patients individual counselling by genetics units staff, giving more consideration to patients' world-view, the purpose of the test and the test result.
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Affiliation(s)
- Tarja Nyrhinen
- TUCH Laboratories, Department of Clinical Chemistry, Turku University Hospital Kiinamyllynkatu 4-8, 20520 Turku, Finland.
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Abstract
Genetic tests are currently being offered to the general public with little oversight and regulation as to which tests are allowed to be sold clinically and little control over the marketing and promotion of sales and use. This article provides discussion and data to indicate that the general public holds high opinions of genetic testing and that current media outlets for public education on genetic testing are not adequate to increase accurate knowledge of genetics. The authors argue that more regulation is needed to control and correct this problem in the United States.
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Affiliation(s)
- Deborah J Bowen
- School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.
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5
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Abstract
Few studies have quantitatively evaluated the uptake and outcomes of BRCA1/2 genetic counseling and testing in men. We conducted a prospective longitudinal study to describe and compare uptake of and psychosocial outcomes following BRCA1/2 testing in a sample of men and women at high-risk for carrying a BRCA1/2 mutation. Men (n = 98) and women (n = 243) unaffected with cancer completed baseline assessments prior to genetic counseling and testing and then 6- and 12-months post-testing. Most men (n = 94; 95.9%) opted to have genetic testing, of whom 44 received positive BRCA1/2 genetic test results and 50 received true negative results. Among women, 93.4% had genetic testing, of whom 79 received positive results and 148 received negative results. In multivariate models, male BRCA1/2 carriers reported significantly higher genetic testing distress (6-months: Z = 4.48, P < 0.0001; 12-months: Z = 2.78, P < 0.01) than male non-carriers. After controlling for baseline levels of distress, no statistically significant differences emerged between male and female BRCA1/2 carriers in psychological distress at 12-months post-testing, although absolute differences were evident over time. Predictors of distress related to genetic testing among male carriers at 12-months included higher baseline cancer-specific distress (Z = 4.73, P < 0.0001) and being unmarried (Z = 2.18, P < 0.05). Similarly, baseline cancer-specific distress was independently associated with cancer-specific distress at 6- (Z = 3.66, P < 0.001) and 12-months (Z = 4.44, P < 0.0001) post-testing among male carriers. Clinically, our results suggest that pre-test assessment of distress and creation of educational materials specifically tailored to the needs and concerns of male carriers may be appropriate in this important but understudied high-risk group.
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Affiliation(s)
- Kristi D Graves
- Cancer Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
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Wilde A, Meiser B, Mitchell PB, Hadzi-Pavlovic D, Schofield PR. Community interest in predictive genetic testing for susceptibility to major depressive disorder in a large national sample. Psychol Med 2011; 41:1605-1613. [PMID: 21159212 DOI: 10.1017/s0033291710002394] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite international concern about unregulated predictive genetic testing, there are surprisingly few data on both the determinants of community interest in such testing and its psychosocial impact. METHOD A large population-based public survey with community-dwelling adults (n=1046) ascertained through random digit dialling. Attitudes were assessed by structured interviews. RESULTS The study found strong interest in predictive genetic testing for a reported susceptibility to depression. Once the benefits and disadvantages of such testing had been considered, there was significantly greater interest in seeking such a test through a doctor (63%) compared to direct-to-consumer (DTC; 40%) (p<0.001). Personal history of mental illness [odds ratio (OR) 2.58, p<0.001], self-estimation of being at higher than average risk for depression (OR 1.92, p<0.001), belief that a genetic component would increase rather than decrease stigma (OR 1.62, p<0.001), and endorsement of benefits of genetic testing (OR 3.47, p<0.001) significantly predicted interest in having such a test. CONCLUSIONS Despite finding attitudes that genetic links to mental illness would increase rather than decrease stigma, we found strong community acceptance of depression risk genotyping, even though a predisposition to depression may only manifest upon exposure to stressful life events. Our results suggest that there will be a strong demand for predictive genetic testing.
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Affiliation(s)
- A Wilde
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Bates MD, Griffin MTQ, Killion CM, Fitzpatrick JJ. African-American males' knowledge and attitudes toward genetic testing and willingness to participate in genetic testing: a pilot study. J Natl Black Nurses Assoc 2011; 22:1-7. [PMID: 21888145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This descriptive pilot study explored the knowledge and attitudes of African-American males toward genetic testing and their willingness to participate in genetic testing. A convenience sample of 104 African-American males, from 19 to 79 years of age, was recruited from a national fraternity meeting. Data were collected using four surveys: Demographic and Background Data, Perceived Knowledge of Genetic Testing, Attitudes Toward Genetic Testing, and Willingness to Participate in Genetic Testing. Perceived genetic knowledge was low with a mean score of 5.6; however, participants had a favorable attitude toward genetic testing. Findings from this study suggested that participants were willing to participate in genetic testing with a total score of 46.8. Significant correlations existed between perceived genetic knowledge and willingness to participate in genetic testing. Interventions to increase perceived genetic knowledge and educate the participant on who is conducting the test and how the test will be performed may be beneficial to increase participation in genetic testing.
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Porz R, Widdershoven G. Predictive testing and existential absurdity: resonances between experiences around genetic diagnosis and the philosophy of Albert Camus. Bioethics 2011; 25:342-350. [PMID: 20047589 DOI: 10.1111/j.1467-8519.2009.01795.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Predictive genetic testing may confront those affected with difficult life situations that they have not experienced before. These life situations may be interpreted as 'absurd'. In this paper we present a case study of a predictive test situation, showing the perspective of a woman going through the process of deciding for or against taking the test, and struggling with feelings of alienation. To interpret her experiences, we refer to the concept of absurdity, developed by the French Philosopher Albert Camus. Camus' writings on absurdity appear to resonate with patients' stories when they talk about their body and experiences of illness. In this paper we draw on Camus' philosophical essay 'The Myth of Sisyphus' (1942), and compare the absurd experiences of Sisyphus with the interviewee's story. This comparison opens up a field of ethical reflection. We demonstrate that Camus' concept of absurdity offers a new and promising approach to understanding the fragility of patients' situations, especially in the field of predictive testing. We show that people affected might find new meaning through narratives that help them to reconstruct the absurd without totally overcoming it. In conclusion, we will draw out some normative consequences of our narrative approach.
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Affiliation(s)
- Rouven Porz
- Ethics Unit in the University Hospital in Bern, Switzerland University of Amsterdam.
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Vos J, Menko F, Jansen AM, van Asperen CJ, Stiggelbout AM, Tibben A. A whisper-game perspective on the family communication of DNA-test results: a retrospective study on the communication process of BRCA1/2-test results between proband and relatives. Fam Cancer 2011; 10:87-96. [PMID: 20852944 PMCID: PMC3036814 DOI: 10.1007/s10689-010-9385-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective of this paper is to study how DNA-test result information was communicated and perceived within families. A retrospective descriptive study in 13 probands with a BRCA1/2 unclassified variant, 7 with a pathogenic mutation, 5 with an uninformative result, and in 44, 14, and 12 of their 1st and 2nd degree relatives respectively. We examined differences and correlations between: (a) information actually communicated (b) probands' perception, (c) relatives' perception. The perception consisted of recollections and interpretations of both their own and their relatives' cancer-risks, and heredity-likelihood (i.e. likelihood that cancer is heritable in the family). Differences and low correlations suggested few similarities between the actually communicated information, the probands' and the relatives' perception. More specifically, probands recalled the communicated information differently compared with the actually communicated information (R = .40), and reinterpreted this information differently (R = .30). The relatives' perception was best correlated with the proband's interpretation (R = .08), but this perception differed significantly from their proband's perception. Finally, relatives reinterpreted the information they received from their proband differently (R = .25), and this interpretation was only slightly related with the original message communicated by the genetic-counsellor (R = .15). Unclassified-variants were most frequently misinterpreted by probands and relatives, and had the largest differences between probands' and relatives' perceptions. Like in a children's whisper-game, many errors occur in the transmission of DNA-test result information in families. More attention is required for how probands disseminate information to relatives. Genetic-counsellors may help by supporting the probands in communicating to relatives, e.g. by providing clear summary letters for relatives.
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Affiliation(s)
- Joël Vos
- Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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10
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Aktan-Collan KI, Kääriäinen HA, Kolttola EM, Pylvänäinen K, Järvinen HJ, Haukkala AH, Mecklin JP. Sharing genetic risk with next generation: mutation-positive parents' communication with their offspring in Lynch Syndrome. Fam Cancer 2011; 10:43-50. [PMID: 20857224 DOI: 10.1007/s10689-010-9386-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 12/18/2022]
Abstract
Identification of hereditary predisposition to cancer has limited significance if not followed by efficient cancer prevention. The responsibility of informing offspring about genetic risk often falls to the parents. We systematically investigated how parents with Lynch Syndrome share knowledge of genetic risk with their offspring, challenges in the communication process and wish for professional support. Of all known mutation carriers over age 40 (n = 337) in 102 Finnish Lynch Syndrome families, 86% completed a self-reported questionnaire; 248 of them (86%) had children. Of the 248 parents, 87% reported disclosure and 13% nondisclosure. Reasons for nondisclosure were mainly the young age of offspring, socially distant relationships, or feeling of difficulty in discussing the topic. Men reported significantly more often disclosure with a support person (spouse etc.) (P < 0.001). The most difficult communication aspect was discussing children's cancer risk. Of the 191 firstborn adult children informed, 69% had taken the predictive genetic test. Every third parent suggested that health professionals should be involved in passing on the information and that a family appointment at the genetic clinic should be organized at the time of disclosure. Nearly all parents had informed their adult offspring about the genetic risk and possibility of genetic testing, but almost one-third were unsure of how their offspring had used the information. The challenge is to improve the communication processes, so that all offspring would get the information important for their health care, and parents would get the professional support desired at disclosure.
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Affiliation(s)
- Katja I Aktan-Collan
- Department of Medical Genetics, Haartman Institute Biomedicum, University of Helsinki, Helsinki, Finland.
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Lebel RR. That personal touch. Hastings Cent Rep 2011; 41:6-7. [PMID: 21678802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
BACKGROUND The use of direct-to-consumer genomewide profiling to assess disease risk is controversial, and little is known about the effect of this technology on consumers. We examined the psychological, behavioral, and clinical effects of risk scanning with the Navigenics Health Compass, a commercially available test of uncertain clinical validity and utility. METHODS We recruited subjects from health and technology companies who elected to purchase the Health Compass at a discounted rate. Subjects reported any changes in symptoms of anxiety, intake of dietary fat, and exercise behavior at a mean (±SD) of 5.6±2.4 months after testing, as compared with baseline, along with any test-related distress and the use of health-screening tests. RESULTS From a cohort of 3639 enrolled subjects, 2037 completed follow-up. Primary analyses showed no significant differences between baseline and follow-up in anxiety symptoms (P=0.80), dietary fat intake (P=0.89), or exercise behavior (P=0.61). Secondary analyses revealed that test-related distress was positively correlated with the average estimated lifetime risk among all the assessed conditions (β=0.117, P<0.001). However, 90.3% of subjects who completed follow-up had scores indicating no test-related distress. There was no significant increase in the rate of use of screening tests associated with genomewide profiling, most of which are not considered appropriate for screening asymptomatic persons in any case. CONCLUSIONS In a selected sample of subjects who completed follow-up after undergoing consumer genomewide testing, such testing did not result in any measurable short-term changes in psychological health, diet or exercise behavior, or use of screening tests. Potential effects of this type of genetic testing on the population at large are not known. (Funded by the National Institutes of Health and Scripps Health.).
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Affiliation(s)
- Cinnamon S Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Health, La Jolla, CA 92037, USA
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Affiliation(s)
- Marilyn E Coors
- Center for Bioethics & Humanities, University of Colorado Denver, Aurora, Colorado 80045, USA.
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McAllister M, Dunn G, Todd C. Empowerment: qualitative underpinning of a new clinical genetics-specific patient-reported outcome. Eur J Hum Genet 2011; 19:125-30. [PMID: 20924407 PMCID: PMC3021496 DOI: 10.1038/ejhg.2010.160] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [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: 01/27/2010] [Revised: 06/30/2010] [Accepted: 08/26/2010] [Indexed: 11/09/2022] Open
Abstract
Recent qualitative research developed a new construct labelled Empowerment describing a new patient outcome from using clinical genetics services that included four dimensions: Knowledge and Understanding, Decision-Making, Instrumentality and Future-Orientation. The aim of this study was to explore the validity, relevance and importance of the Empowerment construct for use as a patient-reported outcome (PRO) for clinical genetics services, and to refine the construct if necessary. Qualitative research (interviews and focus groups) was conducted in the UK with 12 patients, 15 representatives from patient support groups, 10 genetics clinicians and 4 service commissioners. Participants were asked to (1) describe what they think are the patient benefits from using clinical genetics services and (2) critique the Empowerment construct as a PRO. Interviews and focus groups were transcribed in full and analyzed using grounded theory. Findings confirmed the relevance and importance of the Empowerment construct, and identified Emotional Regulation as a further dimension of Empowerment. Data analysis also resulted in refinement of the construct, by renaming the other four dimensions to be Cognitive Control, Decisional Control, Behavioural Control and Hope. Empowerment has the potential to be a useful PRO to evaluate interventions in clinical genetics, and for use in clinical practice to generate data for continuous quality improvement. A study is underway to operationalise Empowerment by developing a psychometrically sound PRO measure that will take the form of a short questionnaire.
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Affiliation(s)
- Marion McAllister
- Medical Genetics Research Group, School of Biomedicine, The University of Manchester, The Nowgen Centre for Genetics in Healthcare, Manchester, UK.
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Hilgart J, Phelps C, Bennett P, Hood K, Brain K, Murray A. "I have always believed I was at high risk..." The role of expectation in emotional responses to the receipt of an average, moderate or high cancer genetic risk assessment result: a thematic analysis of free-text questionnaire comments. Fam Cancer 2010; 9:469-77. [PMID: 20119651 DOI: 10.1007/s10689-010-9324-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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: 12/19/2022]
Abstract
It is well-recognised that receipt of cancer genetic risk information can evoke a mix of both positive and negative emotional responses. Objective risk itself is not necessarily predictive of emotional response to receipt of risk information and the Cue Adaptive Reasoning Account (CARA; Renner, 2004) suggests that that the degree to which level of risk is consistent with expectations may influence emotional responses. This paper reports a thematic analysis of the free-text data structured around responses to the three risk labels: average, moderate or high. Data is reported from both 123 women and 15 men, including those with a past or current cancer diagnosis. Reactions to risk information appear to be dependent upon participants' pre-conceived expectations about their level of cancer risk. Many average risk respondents questioned the accuracy of their result, whereas high risk information was often expected. Findings are discussed in relation to the CARA model and clinical implications.
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Affiliation(s)
- J Hilgart
- Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, Wales, UK.
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Dancyger C, Smith JA, Jacobs C, Wallace M, Michie S. Comparing family members' motivations and attitudes towards genetic testing for hereditary breast and ovarian cancer: a qualitative analysis. Eur J Hum Genet 2010; 18:1289-95. [PMID: 20648056 PMCID: PMC3002862 DOI: 10.1038/ejhg.2010.114] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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] [Received: 12/08/2009] [Revised: 05/14/2010] [Accepted: 06/04/2010] [Indexed: 11/09/2022] Open
Abstract
Genetic testing for hereditary breast and ovarian cancer reveals significant risk information regarding one's chances of developing cancer that has potential implications for patients and their families. This study reports on the motivations and attitudes of index patients and their relatives towards genetic testing for hereditary breast and ovarian cancer. In total, 10 female index patients and 20 of their relatives were interviewed regarding their experiences of communicating genetic information within their families, and their motivations and attitudes towards genetic testing. The analysis found two types of 'family groups': groups strongly committed to genetic testing and groups uncertain about testing. Within committed family groups, index patients and their relatives felt obliged to be tested for others, leading some relatives to be tested without having fully thought through their decision or the implications of knowing their mutation status. These family groups also described considerations in relation to the value of testing for themselves. In family groups uncertain about testing, relatives had not attended for predictive testing, had postponed decision making until some point in the future or had expressed ambivalence about the value of testing for themselves. Results suggest the value of explicitly acknowledging motivations for genetic testing within the context of family obligations, relationships and communication, and the possible value of involving family members in genetic counselling and decision making from a family's first contact with genetic services.
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Affiliation(s)
- Caroline Dancyger
- BPS Centre for Outcome Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Tsianakas V, Calnan M, Atkin K, Dormandy E, Marteau TM. Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of GPs' experiences. Br J Gen Pract 2010; 60:822-8. [PMID: 21062549 PMCID: PMC2965967 DOI: 10.3399/bjgp10x532602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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] [Received: 07/17/2009] [Revised: 03/30/2010] [Accepted: 05/20/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Timely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation. AIM To assess the feasibility of offering antenatal SC&T screening in primary care at the time of pregnancy confirmation. DESIGN OF STUDY Cross-sectional investigation of GPs' beliefs and perceived practices. METHOD Informal face-to-face interviews with 34 GPs. SETTING Seventeen inner-city general practices that offered antenatal SC&T screening as part of a trial. RESULTS GPs identified both barriers and facilitators. Organisational barriers included inflexible appointment systems and lack of interpreters for women whose first language was not English. Professional barriers included concerns about raising possible adverse outcomes in the first antenatal visit. Perceived patient barriers included women's lack of awareness of SC&T. Hence, GPs presented the test to women as routine, rather than as a choice. Organisational facilitators included simple and flexible systems for offering screening in primary care, practice cohesion, and training. Professional facilitators included positive attitudes to screening for SC&T. Perceived patient facilitators included women's desire for healthy children. CONCLUSION GPs reported barriers, as well as facilitators, to successful implementation but the extent to which screening could be regarded as offering 'informed choice' remained fundamental when making sense of these barriers and facilitators.
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Cherkas LF, Harris JM, Levinson E, Spector TD, Prainsack B. A survey of UK public interest in internet-based personal genome testing. PLoS One 2010; 5:e13473. [PMID: 20976053 PMCID: PMC2957412 DOI: 10.1371/journal.pone.0013473] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 09/30/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In view of the increasing availability of commercial internet-based Personal Genome Testing (PGT), this study aimed to explore the reasons why people would consider taking such a test and how they would use the genetic risk information provided. METHODOLOGY/PRINCIPAL FINDINGS A self-completion questionnaire assessing public awareness and interest in PGT and motivational reasons for undergoing PGT was completed by 4,050 unselected adult volunteers from the UK-based TwinsUK register, aged 17 to 91 (response rate 62%). Only 13% of respondents were aware of the existence of PGT. After reading a brief summary about PGT, one in twenty participants (5%) were potentially interested at current prices (£250), however this proportion rose to half (50%) if the test was free of charge. Nearly all respondents who were interested in free PGT reported they would take the test to encourage them to adopt a healthier lifestyle if found to be at high genetic risk of a disease (93%). Around 4 in 5 respondents would have the test to convey genetic risk information to their children and a similar proportion felt that having a PGT would enable their doctor to monitor their health more closely. A TwinsUK research focus group also indicated that consumers would consult their GP to help interpret results of PGT. CONCLUSIONS/SIGNIFICANCE This hypothetical study suggests that increasing publicity and decreasing costs of PGT may lead to increased uptake, driven in part by the general public's desire to monitor and improve their health. Although the future extent of the clinical utility of PGT is currently unknown, it is crucial that consumers are well informed about the current limitations of PGT. Our results suggest that health professionals will inevitably be required to respond to individuals who have undergone PGT. This has implications for health service providers regarding both cost and time.
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Affiliation(s)
- Lynn F Cherkas
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom.
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Marteau TM, French DP, Griffin SJ, Prevost AT, Sutton S, Watkinson C, Attwood S, Hollands GJ. Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours. Cochrane Database Syst Rev 2010:CD007275. [PMID: 20927756 DOI: 10.1002/14651858.cd007275.pub2] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are high expectations regarding the potential for the communication of DNA-based disease risk estimates to motivate behaviour change. OBJECTIVES To assess the effects of communicating DNA-based disease risk estimates on risk-reducing behaviours and motivation to undertake such behaviours. SEARCH STRATEGY We searched the following databases using keywords and medical subject headings: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2010), MEDLINE (1950 to April 2010), EMBASE (1980 to April 2010), PsycINFO (1985 to April 2010) using OVID SP, and CINAHL (EBSCO) (1982 to April 2010). We also searched reference lists, conducted forward citation searches of potentially eligible articles and contacted authors of relevant studies for suggestions. There were no language restrictions. Unpublished or in press articles were eligible for inclusion. SELECTION CRITERIA Randomised or quasi-randomised controlled trials involving adults (aged 18 years and over) in which one group received actual (clinical studies) or imagined (analogue studies) personalised DNA-based disease risk estimates for diseases for which the risk could plausibly be reduced by behavioural change. Eligible studies had to include a primary outcome measure of risk-reducing behaviour or motivation (e.g. intention) to alter such behaviour. DATA COLLECTION AND ANALYSIS Two review authors searched for studies and independently extracted data. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous outcome measures, we report effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we report effect sizes as odds ratios (ORs). We obtained pooled effect sizes with 95% confidence intervals (CIs) using the random effects model applied on the scale of standardised differences and log odds ratios. MAIN RESULTS We examined 5384 abstracts and identified 21 studies as potentially eligible. Following a full text analysis, we included 14 papers reporting results of 7 clinical studies (2 papers report on the same trial) and 6 analogue studies.Of the seven clinical studies, five assessed smoking cessation. Meta-analyses revealed no statistically significant effects on either short-term (less than 6 months) smoking cessation (OR 1.35, 95% CI 0.76 to 2.39, P = 0.31, n = 3 studies) or cessation after six months (OR 1.07, 95% CI 0.64 to 1.78, P = 0.80, n = 4 studies). Two clinical studies assessed diet and found effects that significantly favoured DNA-based risk estimates (OR 2.24, 95% CI 1.17 to 4.27, P = 0.01). No statistically significant effects were found in the two studies assessing physical activity (OR 1.03, 95% CI 0.59 to 1.80, P = 0.92) or the one study assessing medication or vitamin use aimed at reducing disease risks (OR 1.26, 95% CI 0.58 to 2.72, P = 0.56). For the six non-clinical analogue studies, meta-analysis revealed a statistically significant effect of DNA-based risk on intention to change behaviour (SMD 0.16, 95% CI 0.04 to 0.29, P = 0.01).There was no evidence that communicating DNA-based disease risk estimates had any unintended adverse effects. Two studies that assessed fear arousal immediately after the presentation of risk information did, however, report greater fear arousal in the DNA-based disease risk estimate groups compared to comparison groups.The quality of included studies was generally poor. None of the clinical or analogue studies were considered to have a low risk of bias, due to either a lack of clarity in reporting, or where details were reported, evidence of a failure to sufficiently safeguard against the risk of bias. AUTHORS' CONCLUSIONS Mindful of the weak evidence based on a small number of studies of limited quality, the results of this review suggest that communicating DNA-based disease risk estimates has little or no effect on smoking and physical activity. It may have a small effect on self-reported diet and on intentions to change behaviour. Claims that receiving DNA-based test results motivates people to change their behaviour are not supported by evidence. Larger and better-quality RCTs are needed.
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Affiliation(s)
- Theresa M Marteau
- Health Psychology Section, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London, UK, SE1 9RT
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Williams JK, Erwin C, Juhl A, Mills J, Brossman B, Paulsen JS. Personal factors associated with reported benefits of Huntington disease family history or genetic testing. Genet Test Mol Biomarkers 2010; 14:629-36. [PMID: 20722493 PMCID: PMC2957234 DOI: 10.1089/gtmb.2010.0065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS A family history of Huntington disease (HD) or receiving results of HD predictive genetic testing can influence individual well-being, family relationships, and social interactions in positive and negative ways. The aim of this study was to examine benefits reported by people with an HD family history or those who have undergone predictive HD testing, as well as the personal variables associated with perceived benefits. METHODS Seventy-four of 433 people completing the International Response of a Sample Population to HD risk (I-RESPOND-HD) survey reported benefits. Knowledge and understanding was perceived as the most common benefit from participants in both groups. The next most frequent perceived benefits from a family history were connecting with others and achieving life meaning and insights. The next most common perceived benefits from genetic testing were life planning and social support. The least common perceived benefit for both groups was renewed hope and optimism. Older age and spirituality were significantly associated with benefits in both groups. CONCLUSIONS Perceptions of benefit may not be as likely until later years in people with prodromal HD. A developed sense of spirituality is identified as a personal resource associated with the perception of benefit from genetic testing for HD. Associations among spirituality, perceived benefits, and other indicators of personal and family well-being may be useful in genetic counseling and health care of people with prodromal HD.
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Affiliation(s)
| | - Cheryl Erwin
- Department of Family Medicine, John P. McGovern Center for Health, Humanities, and the Human Spirit, University of Texas Medical School of Houston, Houston, Texas
| | - Andrew Juhl
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - James Mills
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Bradley Brossman
- TIMSS and PIRLS International Study Center, Boston College, Boston, Massachusetts
| | - Jane S. Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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Ahman A, Runestam K, Sarkadi A. Did I really want to know this? Pregnant women's reaction to detection of a soft marker during ultrasound screening. Patient Educ Couns 2010; 81:87-93. [PMID: 20083367 DOI: 10.1016/j.pec.2009.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 12/16/2009] [Accepted: 12/20/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate women's expectations of routine ultrasound and experiences when soft markers were discovered: what the disclosure meant, how it affected them, how they experienced the information given and why they did or did not choose amniocentesis. DESIGN Semi-structured, in-depth interviews were conducted with 11 women 25-30 weeks into the pregnancy, 7-13 weeks after the discovery of a soft marker. FINDINGS Women lacked knowledge about the potential of the scan and detection of soft markers created strong emotional reactions that women thought could have been alleviated by prior information about potential findings. Information in connection with the scan was perceived as insufficient. Decision about amniocentesis was affected by attitudes to disability, anxiety about fetal loss due to the procedure, need for certainty by a diagnostic test, and partner's opinion. CONCLUSIONS Women were shocked by the unexpected and sometimes unwanted information on elevated risk for a chromosomal aberration for which they lacked any preparation. Because this event often has long-lasting effects on the pregnancy, models of information that are efficient in promoting informed decisions are imperative. PRACTICE IMPLICATIONS Both women and their partners need relevant information before and in connection with ultrasound scan to be able to make informed choices.
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Affiliation(s)
- Annika Ahman
- Department of Women's and Children's Health, Uppsala University Hospital, Sweden.
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22
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Sakurai A. [Genetic tests for affected patients, asymptomatic subjects at risk, and predictive testing]. Nihon Rinsho 2010; 68 Suppl 8:177-182. [PMID: 20976898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Akihiro Sakurai
- Department of Molecular Genetics, Shinshu University School of Medicine
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Schwartz RR. Ripples from a stone skipping across the lake: a narrative approach to the meaning of Huntington's disease. J Neurosci Nurs 2010; 42:157-168. [PMID: 20550076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Huntington's disease (HD) is a progressive neurogenetic disorder that has a 50% inheritance rate. The ability to have 100% confirmation of the illness became a reality with the discovery of the gene in 1993. The effect of confirmatory testing and the issues faced by the individual and the family facing diagnosis have not been addressed. The purpose of this research study was to explore the meaning of being diagnosed with HD using narrative inquiry. Ten participants, during the first year of diagnosis, were asked to tell their story of what it meant to be diagnosed with HD. A holistic-content approach was used for data analysis. An integrated narrative, "The Story of HD: Ripples From a Stone Skipping Across the Lake," was created from the stories. The stories were analyzed for plot, predicaments, protagonist, and antagonist. The predicaments of "discovering the existence of HD," "confirming the diagnosis of HD," "revealing the diagnosis to others," and "experiencing the reverberations of HD" served as the main chapters that formed the structure of the stories. Each predicament contains a set of themes that function as subheadings for the chapters. In the final chapter or epilogue, participants were asked to reflect on the meaning of being diagnosed with HD. The psychological impact of receiving a positive genetic diagnosis has implications for patients and their extended families. Nurses should develop their understanding of the role of genetics in healthcare today. Clinical evaluations of the effectiveness of treatments and assessment for changes in mood, behavior, and motor function are an essential part of nursing care. Advocacy and supportive roles must be incorporated into the patient visit. Patient education material on home safety, nutrition, medication management, and general health practices should be provided during the outpatient visits. Through the development of a more comprehensive role, the nurse can assist patients and families in finding the personal meaning of being diagnosed.
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Abstract
Genetic testing to identify susceptibility to a variety of common complex diseases is increasingly becoming available. In this article, focusing on the development of genetic susceptibility testing for diet-related disease, I examine the emergence of direct-to-the-consumer genetic testing services and the (re)configuration of healthcare provision, both within and outside the specialist genetics service, in the UK. I identify two key techniques within these practices: empowerment and facilitation. Using Foucauldian social theory, I show that empowerment and facilitation are being positioned as tools for the creation of citizen-consumers who will make appropriate dietary choices, based on the results of their genetic analysis. Through these techniques, individuals are transformed into properly entrepreneurial citizens who will, through judicious choices, act to maximise their 'vital capital' (their health) and the capital of the social body. I argue that the user of these services is not purely an economic figure, making rational choices as a consumer, but that her configuration as a citizen-consumer who avails herself of genetic information and services in a proper manner ensures that she is fit to contribute to the economic life of our present.
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Affiliation(s)
- Alison Harvey
- Centre for Biomedicine and Society, King's College London, Strand, London.
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25
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26
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Sherman KA, Kasparian NA, Mireskandari S. Psychological adjustment among male partners in response to women's breast/ovarian cancer risk: a theoretical review of the literature. Psychooncology 2010; 19:1-11. [PMID: 19472298 DOI: 10.1002/pon.1582] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kerry A Sherman
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.
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Katz G, Schweitzer SO. Implications of genetic testing for health policy. Yale J Health Policy Law Ethics 2010; 10:90-134. [PMID: 20229845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Wilde A, Meiser B, Mitchell PB, Schofield PR. Public interest in predictive genetic testing, including direct-to-consumer testing, for susceptibility to major depression: preliminary findings. Eur J Hum Genet 2010; 18:47-51. [PMID: 19690586 PMCID: PMC2987161 DOI: 10.1038/ejhg.2009.138] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [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: 01/08/2009] [Revised: 07/10/2009] [Accepted: 07/15/2009] [Indexed: 11/09/2022] Open
Abstract
The past decade has seen rapid advances in the identification of associations between candidate genes and a range of common multifactorial disorders. This paper evaluates public attitudes towards the complexity of genetic risk prediction in psychiatry involving susceptibility genes, uncertain penetrance and gene-environment interactions on which successful molecular-based mental health interventions will depend. A qualitative approach was taken to enable the exploration of the views of the public. Four structured focus groups were conducted with a total of 36 participants. The majority of participants indicated interest in having a genetic test for susceptibility to major depression, if it was available. Having a family history of mental illness was cited as a major reason. After discussion of perceived positive and negative implications of predictive genetic testing, nine of 24 participants initially interested in having such a test changed their mind. Fear of genetic discrimination and privacy issues predominantly influenced change of attitude. All participants still interested in having a predictive genetic test for risk for depression reported they would only do so through trusted medical professionals. Participants were unanimously against direct-to-consumer genetic testing marketed through the Internet, although some would consider it if there was suitable protection against discrimination. The study highlights the importance of general practitioner and public education about psychiatric genetics, and the availability of appropriate treatment and support services prior to implementation of future predictive genetic testing services.
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Affiliation(s)
- Alex Wilde
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
- Brain Sciences UNSW, Sydney, NSW, Australia
| | - Peter R Schofield
- Prince of Wales Medical Research Institute, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Brain Sciences UNSW, Sydney, NSW, Australia
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Abstract
Shopping for genetic information has become popular, but consumers may not understand what exactly they are buying. The retail DNA industry is forcing laypersons, academics, and medical and legal professionals alike to face the crossroads of genetics, law, and society. How will we decipher the meanings of the tests, determine the value of the information provided, or appropriately encourage or discourage various applications of that genetic information? When it comes to understanding the signs at the crossroads of disciplines, something is always potentially lost in translation. This article provides an overview of the retail DNA industry, addressing a few questions ripe for misinterpretation and confusion. It argues that the challenges posed by the retail DNA industry are both intelligible and manageable; optimally, multidisciplinary individuals would guide the way, steering the courts, legislature, laboratories, and clinics toward an adequate balance of consumer protection, autonomy, and understanding.
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Affiliation(s)
- Jennifer K Wagner
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA.
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Mand C, Duncan RE, Gillam L, Collins V, Delatycki MB. Genetic selection for deafness: the views of hearing children of deaf adults. J Med Ethics 2009; 35:722-728. [PMID: 19948926 DOI: 10.1136/jme.2009.030429] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The concept of selecting for a disability, and deafness in particular, has triggered a controversial and sometimes acrimonious debate between key stakeholders. Previous studies have concentrated on the views of the deaf and hard of hearing, health professionals and ethicists towards reproductive selection for deafness. This study, however, is the first of its kind examining the views of hearing children of deaf adults towards preimplantation genetic diagnosis and prenatal diagnosis to select for or against deafness. Hearing children of deaf adults (or CODAs, as they call themselves, and are widely known in the deaf community) straddle both the deaf and hearing worlds, and this dual perspective makes them ideally placed to add to the academic discourse concerning the use of genetic selection for or against deafness. The study incorporated two complementary stages, using initial, semistructured interviews with key informants (CODAs and health professionals) as a means to guide the subsequent development of an electronic survey, completed anonymously by 66 individuals. The participants shared many of the same views as deaf individuals in the D/deaf (or "culturally deaf") community. The similarities extended to their opinions regarding deafness not being a disability (45.5% believed deafness was a distinct culture rather than a disability), their ambivalence towards having hearing or deaf children (72.3% indicated no preference) and their general disapproval of the use of genetic technologies to select either for or against deafness (60% believed that reproductive technologies, when used to select for or against deafness, should not be available to the community).
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Affiliation(s)
- C Mand
- Bruce Lefroy Centre for Genetic Health Research, Royal Children's Hospital, Parkville, 3052, Victoria, Australia
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Ashida S, Koehly LM, Roberts JS, Chen CA, Hiraki S, Green RC. Disclosing the disclosure: factors associated with communicating the results of genetic susceptibility testing for Alzheimer's disease. J Health Commun 2009; 14:768-84. [PMID: 20029710 PMCID: PMC2801901 DOI: 10.1080/10810730903295518] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study explored the extent to which recipients of genetic susceptibility testing for Alzheimer's disease (AD) communicated their results to others. It also examined demographic characteristics, along with beliefs about AD, associated with such communication. Participants (N = 271) in a randomized clinical trial involving genetic testing for Apolipoprotein E (APOE) gene variants among first-degree relatives of AD patients reported their communication behaviors 6 weeks after the results disclosure. Information on beliefs about AD and genetic testing was collected at baseline. Eighty-two percent of participants receiving APOE genotype information shared their results with someone. Specifically, 64% shared with family members, 51% with spouse or significant others, 35% with friends, and 12% with health care professionals. Greater AD treatment optimism was associated with communicating results to family (OR = 1.43), spouse (OR = 1.62), friends (OR = 1.81), and health care professionals (OR = 2.20). Lower perceived risk (OR = 0.98) and higher perceived importance of genetics in the development of AD (OR = 1.93) were associated with results communication in general. Lower perceived drawbacks of AD genetic testing was associated with results communication to friends (OR = 0.65). Beliefs about AD risks and causes, genetic testing, and development of treatments partly may determine the interpersonal communication patterns of genetic susceptibility test results.
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Affiliation(s)
- Sato Ashida
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland 20892-2073, USA.
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Raz AE, Schicktanz S. Diversity and uniformity in genetic responsibility: moral attitudes of patients, relatives and lay people in Germany and Israel. Med Health Care Philos 2009; 12:433-42. [PMID: 19629747 PMCID: PMC2777202 DOI: 10.1007/s11019-009-9215-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 06/30/2009] [Indexed: 05/21/2023]
Abstract
The professional and institutional responsibility for handling genetic knowledge is well discussed; less attention has been paid to how lay people and particularly people who are affected by genetic diseases perceive and frame such responsibilities. In this exploratory study we qualitatively examine the attitudes of lay people, patients and relatives of patients in Germany and Israel towards genetic testing. These attitudes are further examined in the national context of Germany and Israel, which represent opposite regulatory approaches and bioethical debates concerning genetic testing. Three major themes of responsibility emerged from the inter-group and cross-cultural comparison: self-responsibility, responsibility for kin, and responsibility of society towards its members. National contrast was apparent in the moral reasoning of lay respondents concerning, for example, the right not to know versus the duty to know (self-responsibility) and the moral conflict concerning informing kin versus the moral duty to inform (responsibility for kin). Attitudes of respondents affected by genetic diseases were, however, rather similar in both countries. We conclude by discussing how moral discourses of responsibility are embedded within cultural (national, religious) as well as phenomenological (being affected) narratives, and the role of public engagement in bioethical discourse.
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Affiliation(s)
- Aviad E. Raz
- Department of Sociology and Anthropology, Ben Gurion University, Beersheba, Israel
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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De Marco M. Views on personalized medicine: do the attitudes of African American and white prescription drug consumers differ? Public Health Genomics 2009; 13:276-83. [PMID: 19776555 PMCID: PMC2914357 DOI: 10.1159/000242199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 11/19/2022] Open
Abstract
AIMS Although recent advances in pharmacogenomics are making possible the use of genetic testing to determine the best medication for patients, little is known about how patients view such procedures. The aims for this study that were developed collaboratively as part of a community-academic partnership are: (1) What are the attitudes and perceptions of prescription drug consumers concerning personalized medicine and genetic testing for drug compatibility and how do they differ between African American and white patients? (2) What are the attitudes and perceptions of patients concerning race-based prescribing and how do they differ between African American and white patients? METHODS We conducted 6 focus groups, 2 with white participants and 4 with African American participants. Focus groups were audio-recorded, transcribed, and analyzed to ascertain common themes. RESULTS Our results suggest that personalized medicine and genetic testing, though not well understood by lay persons, were considered positive advances in medicine. However, participants also voiced concerns about these advances that differed by race. CONCLUSION This study points to the need to include perspectives of at-risk communities as we move toward wider use of this technology.
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Affiliation(s)
- M. De Marco
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, N.C., USA
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Abstract
Genetic testing for adult-onset diseases is now available. One such test is for the mutations present in the BRCA gene that result in a significantly higher risk for the development of breast cancer or ovarian cancer. Women who have one of these mutations face difficult choices in terms of increased surveillance or prophylactic surgeries. Examining experiences of women with BRCA mutations can serve as an exemplar for other populations at risk for genetically associated adult-onset diseases.
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Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Riedijk SR, Niermeijer MFN, Dooijes D, Tibben A. A decade of genetic counseling in frontotemporal dementia affected families: few counseling requests and much familial opposition to testing. J Genet Couns 2009; 18:350-6. [PMID: 19360462 PMCID: PMC2706981 DOI: 10.1007/s10897-009-9222-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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: 10/02/2008] [Accepted: 01/29/2009] [Indexed: 11/18/2022]
Abstract
A decade of genetic counseling of frontotemporal dementia (FTD) affected families has generated two important observations. First, the uptake rate for presymptomatic testing for FTD is low in our department of Clinical Genetics at the Erasmus Medical Center in the Netherlands. Second, FTD at-risk counselees reported substantial familial opposition to genetic testing, which is distinct from the attitude in Huntington Disease affected families. We hypothesize that the low acceptance for FTD genetic counseling is consequential to the familial opposition and explain this within the theoretical framework of separation-individuation. Furthermore, we hypothesize that separation-individuation problems do not similarly influence the acceptance of HD genetic counseling, due to the educative role of the well-organised patient organization for HD in the Netherlands. We offer counseling recommendations that serve to facilitate the individuation of the counselee with respect to the FTD genetic test.
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Affiliation(s)
- S R Riedijk
- Department of Clinical Genetics, Erasmus Medical Centre, Westzeedijk 112, 3016 AH Rotterdam, The Netherlands,
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Green RC, Roberts JS, Cupples LA, Relkin NR, Whitehouse PJ, Brown T, Eckert SL, Butson M, Sadovnick AD, Quaid KA, Chen C, Cook-Deegan R, Farrer LA. Disclosure of APOE genotype for risk of Alzheimer's disease. N Engl J Med 2009; 361:245-54. [PMID: 19605829 PMCID: PMC2778270 DOI: 10.1056/nejmoa0809578] [Citation(s) in RCA: 338] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The apolipoprotein E (APOE) genotype provides information on the risk of Alzheimer's disease, but the genotyping of patients and their family members has been discouraged. We examined the effect of genotype disclosure in a prospective, randomized, controlled trial. METHODS We randomly assigned 162 asymptomatic adults who had a parent with Alzheimer's disease to receive the results of their own APOE genotyping (disclosure group) or not to receive such results (nondisclosure group). We measured symptoms of anxiety, depression, and test-related distress 6 weeks, 6 months, and 1 year after disclosure or nondisclosure. RESULTS There were no significant differences between the two groups in changes in time-averaged measures of anxiety (4.5 in the disclosure group and 4.4 in the nondisclosure group, P=0.84), depression (8.8 and 8.7, respectively; P=0.98), or test-related distress (6.9 and 7.5, respectively; P=0.61). Secondary comparisons between the nondisclosure group and a disclosure subgroup of subjects carrying the APOE epsilon4 allele (which is associated with increased risk) also revealed no significant differences. However, the epsilon4-negative subgroup had a significantly lower level of test-related distress than did the epsilon4-positive subgroup (P=0.01). Subjects with clinically meaningful changes in psychological outcomes were distributed evenly among the nondisclosure group and the epsilon4-positive and epsilon4-negative subgroups. Baseline scores for anxiety and depression were strongly associated with post-disclosure scores of these measures (P<0.001 for both comparisons). CONCLUSIONS The disclosure of APOE genotyping results to adult children of patients with Alzheimer's disease did not result in significant short-term psychological risks. Test-related distress was reduced among those who learned that they were APOE epsilon4-negative. Persons with high levels of emotional distress before undergoing genetic testing were more likely to have emotional difficulties after disclosure. (ClinicalTrials.gov number, NCT00571025.)
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Affiliation(s)
- Robert C Green
- Boston University School of Medicine, Boston, MA 02118, USA.
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Mezer E, Babul-Hirji R, Wise R, Chipman M, DaSilva L, Rowell M, Thackray R, Shuman CT, Levin AV. Attitudes Regarding Predictive Testing for Retinitis Pigmentosa. Ophthalmic Genet 2009; 28:9-15. [PMID: 17454742 DOI: 10.1080/13816810701199423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 10/23/2022]
Abstract
PURPOSE To assess attitudes towards predictive testing for autosomal dominant retinitis pigmentosa (ADRP). METHODS A prospective questionnaire study of 46 affected adults and their adult family members identified from pedigrees clearly consistent with ADRP or who had had DNA-testing confirmation of ADRP before the study commenced. RESULTS High proportions of unaffected siblings (73%) and patients (67%) agreed to prenatal testing. Patients agreed to prenatal testing. Patients agreed significantly more often than unaffected siblings that treatment should be available prior to initiating predictive testing. Psychoemotional distress was reported in 57% of the affected adults and their family members in recollecting their own predictive testing as children. CONCLUSIONS ADRP families indicate a favorable attitude towards testing presymptomatic children with counseling to lessen the psychological and social impact of results.
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Affiliation(s)
- Eedy Mezer
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Bombard Y, Veenstra G, Friedman JM, Creighton S, Currie L, Paulsen JS, Bottorff JL, Hayden MR. Perceptions of genetic discrimination among people at risk for Huntington's disease: a cross sectional survey. BMJ 2009; 338:b2175. [PMID: 19509425 PMCID: PMC2694258 DOI: 10.1136/bmj.b2175] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the nature and prevalence of genetic discrimination experienced by people at risk for Huntington's disease who had undergone genetic testing or remained untested. DESIGN Cross sectional, self reported survey. SETTING Seven genetics and movement disorders clinics servicing rural and urban communities in Canada. PARTICIPANTS 233 genetically tested and untested asymptomatic people at risk for Huntington's disease (response rate 80%): 167 underwent testing (83 had the Huntington's disease mutation, 84 did not) and 66 chose not to be tested. MAIN OUTCOME MEASURES Self reported experiences of genetic discrimination and related psychological distress based on family history or genetic test results. RESULTS Discrimination was reported by 93 respondents (39.9%). Reported experiences occurred most often in insurance (29.2%), family (15.5%), and social (12.4%) settings. There were few reports of discrimination in employment (6.9%), health care (8.6%), or public sector settings (3.9%). Although respondents who were aware that they carried the Huntington's disease mutation reported the highest levels of discrimination, participation in genetic testing was not associated with increased levels of genetic discrimination. Family history of Huntington's disease, rather than the result of genetic testing, was the main reason given for experiences of genetic discrimination. Psychological distress was associated with genetic discrimination (P<0.001). CONCLUSIONS Genetic discrimination was commonly reported by people at risk for Huntington's disease and was a source of psychological distress. Family history, and not genetic testing, was the major reason for genetic discrimination.
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Affiliation(s)
- Yvonne Bombard
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
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Maheu C. Implications of living with a strong family history of breast cancer. Can J Nurs Res 2009; 41:100-112. [PMID: 19650516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The findings presented here are from a qualitative study in which data were gathered from 20 women who had received inconclusive genetic testing results for inherited breast cancer susceptibility. Before describing the significance, for them, of their genetic test results, all of the participants related what it was like to live with a strong family history of breast cancer. The focus of this article is the women's experience of living with a personal and strong family history of breast cancer. For these women, having such a history had become a fact of life that could not be ignored.Three themes were identified in the data: expecting and dealing with a diagnosis of breast cancer protecting oneself and others, and increasing exposure to cancer screening procedures. These themes address the underlying reality that having a personal and family history of breast cancer is not an isolated situation but part of one's journey in choosing to undergo genetic testing for inherited breast cancer susceptibility.
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Affiliation(s)
- Christine Maheu
- School of Nursing, York University, Toronto, Ontario, Canada
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Griffith GL, Morrison V, Williams JMG, Edwards RT. Can we assume that research participants are utility maximisers? Eur J Health Econ 2009; 10:187-196. [PMID: 18665410 DOI: 10.1007/s10198-008-0118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 07/03/2008] [Indexed: 05/26/2023]
Abstract
The objective of this study was to experimentally examine by means of an information manipulation if respondents are adhering to the utility theory axiom of utility maximisation. A repeated measure experimental design was used. Assessments were conducted pre- and post-intervention with self-administered questionnaires. The study participants were 158 (142 after exclusions) first year undergraduate students, Bangor University (UK). The intervention-information manipulation-did not induce the hypothesised changes in the perceived pros and cons of, or desire for, genetic testing and counselling for breast cancer; correlation revealed a weak relationship between the pros and cons of and desire for testing and counselling. We conclude that there was no evidence of utility maximisation-the key tenet of utility theory-being used. Given the contradiction between the findings of this study and others, there is a need to conduct further research into utility maximisation.
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Affiliation(s)
- Gethin L Griffith
- Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK.
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Kinney AY, Simonsen SE, Baty BJ, Mandal D, Neuhausen SL, Seggar K, Holubkov R, Smith K. Acceptance of genetic testing for hereditary breast ovarian cancer among study enrollees from an African American kindred. Am J Med Genet A 2009; 140:813-26. [PMID: 16523520 PMCID: PMC2562369 DOI: 10.1002/ajmg.a.31162] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical availability of genetic testing for cancer predisposition genes is generating a major challenge for U.S. health care systems to provide relevant genetic services to underserved populations. Here we present rates of study enrollment and utilization of genetic testing in a research study on BRCA1 testing acceptance in one large kindred. We also present data on baseline access to genetic information as well as enabling and obstructing factors to study enrollment. The study population included female and male members of an African American kindred based in the rural southern United States with an identified BRCA1 mutation. A combination of quantitative and qualitative data were collected and analyzed. Of the 161 living, eligible, and locatable kindred members, 105 (65%) enrolled in the study. Family, personal, and educational motivations were the most commonly endorsed reasons for study participation. The most commonly cited reasons for refusal to participate in the study were: lack of interest, time constraints, and negative experiences with prior participation in genetic research. Eighty three percent of the participants underwent BRCA1 testing. In multiple logistic regression analysis, age 40-49 (odds ratio (OR) = 6.9; 95% confidence interval (CI) = 1.2-39.5), increased perceived risk of being a BRCA1 mutation carrier (OR = 4.1; 95% CI = 1.1-14.6), and high cancer genetics knowledge levels (OR = 1.5; 95% CI = 1.1-2.3) were associated with BRCA1 testing acceptance. The results of this study indicate that cognitive and demographic factors may influence genetic research participation and genetic testing decisions among African Americans who are at increased risk of carrying a deleterious BRCA1 mutation.
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Abstract
Prenatal blood tests are routinely offered to pregnant women in the UK. Male partners are tested only where a combined positive male and female test could detect fetal abnormality such as sickle cell anaemia. Little is known about the gendered nature of screening and the impact it has on lay feelings of genetic responsibility. For example, do women take exclusive 'maternal responsibility' for the fetus? How is this responsibility challenged when men are also screened? Drawing on empirical research with pregnant women and their male partners in a northern city in the UK, this paper aims to explore the gendered nature of genetic responsibility in prenatal blood screening. The paper will argue that women and men feel a sense of genetic responsibility for the fetus throughout screening. However, while women's sense of responsibility is directly 'embodied' and is heightened by the detection of 'faulty genes', men's manifests itself indirectly through shared responsibility with their pregnant partners and directly through their own genetic connections to the fetus. The paper concludes that the gendered nature of genetic responsibility is complex and contradictory, producing a set of gender roles that both challenges and reinforces a traditional gender division of labour.
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Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield.
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Affiliation(s)
- Agatha M Gallo
- College of Nursing in University of Illinois at Chicago, USA.
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Landsbergen KM, Prins JB, Brunner HG, Kraaimaat FW, Hoogerbrugge N. Genetic testing for Lynch syndrome in the first year of colorectal cancer: a review of the psychological impact. Fam Cancer 2009; 8:325-37. [PMID: 19330464 PMCID: PMC2771129 DOI: 10.1007/s10689-009-9239-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 03/14/2009] [Indexed: 01/15/2023]
Abstract
An increasing number of patients with colorectal cancer (CRC) receive genetic counselling within 1 year after diagnosis. Little is known whether specific subgroups are more vulnerable for genetic testing related distress. A literature review was conducted to identify the psychological impact of CRC in the first year, and the additional impact of genetic testing. The electronic databases of PubMed, PsychInfo, Embase and the Cochrane Library were searched to identify all reports published between January 1997 and October 2007 on the psychological impact of (1) CRC-diagnosis up to 1 year after treatment and of (2) genetic testing for Lynch syndrome in patients with CRC. Studies on the psychological impact of genetic testing in newly diagnosed patient with CRC were not available. Either CRC patients diagnosed several years ago were studied and the focus was also often on the psychological impact of genetic testing prior to DNA-test disclosure. They show that limitations in emotional and social functioning can persist up to 1 year after CRC treatment, especially in those with a stoma or diagnosed before age 60. Female patients and male patients diagnosed before age 50 appear to be more vulnerable to genetic test-related distress. It is well known that being treated for CRC has great impact on psychological functioning. Little is known about the psychological impact during the first year after diagnosis and very little is known about the additional psychological effect of genetic testing for hereditary cancer in this period. We found presumptive evidence that specific subgroups of patients with CRC are more vulnerable for genetic-testing-related distress.
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Affiliation(s)
- Karin M Landsbergen
- Department of Human Genetics, Raboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands.
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Rommetveit K, Porz R. Tragedy and Grenzsituationen in genetic prediction. Med Health Care Philos 2009; 12:9-16. [PMID: 18592401 DOI: 10.1007/s11019-008-9139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 12/21/2007] [Indexed: 05/26/2023]
Abstract
Philosophical anthropologies that emphasise the role of the emotions can be used to expand existing notions of moral agency and learning in situations of great moral complexity. In this article we tell the story of one patient facing the tough decision of whether to be tested for Huntington's disease or not. We then interpret her story from two different but compatible philosophical entry points: Aristotle's conception of Greek tragedy and Karl Jaspers' notion of Grenzsituationen (boundary situations). We continue by indicating some ways in which these two positions may be used for reflecting upon different perspectives involved in clinical decision-making, those of patients, clinicians and bioethicists. We conclude that the ideas we introduce can be used as hermeneutic tools for situating learning and dialogue within a broader cultural field in which literature and art may also play important roles.
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Affiliation(s)
- Kjetil Rommetveit
- The Centre for the Study of the Sciences and the Humanities, University of Bergen, Allegt. 32, 5020, Bergen, Norway.
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Abstract
This paper describes two studies about the determinants of attitudes to pre-implantation genetic screening in a multicultural sample of medical students from the United States. Sample sizes were 292 in study 1 and 1464 in study 2. Attitudes were of an undifferentiated nature, but respondents did make a major distinction between use for disease prevention and use for enhancement. No strong distinctions were made between embryo selection and germ line gene manipulations, and between somatic gene therapy and germ line gene manipulations. Religiosity was negatively associated with acceptance of "designer baby" technology for Christians and Muslims but not Hindus. However, the strongest and most consistent influence was an apparently moralistic stance against active and aggressive interference with natural processes in general. Trust in individuals and institutions was unrelated to acceptance of the technology, indicating that fear of abuse by irresponsible individuals and corporations is not an important determinant of opposition.
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Affiliation(s)
- Gerhard Meisenberg
- Department of Biochemistry, Ross University, School of Medicine, Dominica.
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Denayer L, Boogaerts A, Philippe K, Legius E, Evers-Kiebooms G. BRCA1/2 predictive testing and gender: uptake, motivation and psychological characteristics. Genet Couns 2009; 20:293-305. [PMID: 20162864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BRCA1/2 predictive testing and gender: Uptake, motivation and psychological characteristics: Data on male uptake of BRCA1/2 predictive testing and psychological characteristics of males in comparison to females are scarce. We investigated gender differences in the cohort tested at the Center for Human Genetics in Leuven during a 10-year period (1998-2007). Males were significantly older than females. Breast cancer related distress (IES) was significantly lower in men and was not associated with BRCA1 or BRCA2. The groups of both males and females were psychologically stronger than average (SCL-90, UCL) and self-selected. Men were unanimously motivated (personal relevance of 12 motives rated on a Likert scale) by concern for their daughters, and significantly more so than women. One third of them (versus 12% women) referred to child-bearing decisions. Considering all unaffected siblings in the family of origin, uptake of predictive testing was significantly higher in females. Moreover, uptake was significantly higher in women belonging to a BRCA2 than to a BRCA1 family. In the descendants of identified carriers, uptake was predicted by gender and age, but not by the parent's gender or by BRCA1 or BRCA2 status.
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Affiliation(s)
- L Denayer
- Psychosocial Genetics Unit, Center for Human Genetics, University Hospitals, 3000 Leuven, Belgium
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