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Isselhard A, Lautz Z, Rhiem K, Stock S. Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review. Curr Oncol 2023; 30:3590-3608. [PMID: 37185387 PMCID: PMC10136916 DOI: 10.3390/curroncol30040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Female BRCA1/2 pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected BRCA1/2 pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected BRCA1/2 pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
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Psychological Impact of TP53-Variant-Carrier Newborns and Counselling on Mothers: A Pediatric Surveillance Cohort. Cancers (Basel) 2022; 14:cancers14122945. [PMID: 35740610 PMCID: PMC9221115 DOI: 10.3390/cancers14122945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Counselling and genetic testing (CGT) after neonatal screening may increase depression and anxiety (DA) levels during cancer surveillance. This study assessed the DA scores in mothers of newborns from Paraná state, Southern Brazil, carrying the TP53 p.R337H variant. To understand and adjust DA conditions during term of pregnancy, we initially detected sociodemographic covariates [marital status (MS), number of children (NC), and/or education level (EL): MS-NC-EL] on an independent group of pregnant women (not subjected to genetic testing). The Hospital Anxiety and Depression Scale (HADS) was used to assess risk factors in pregnant (cross-sectional analysis) and unrelated mothers (at 2-month intervals, longitudinal study) of TP53 p.R337H-tested newborns (three sessions of HADS analysis) using Wilcoxon (Mann-Whitney) and Kruskal-Wallis nonparametric tests. Lower anxiety levels were observed in mothers of noncarriers (without MS-NC-EL = 6.91 ± 1.19; with MS-NC-EL = 6.82 ± 0.93) than in mothers of p.R337H carriers in the first session (without MS-NC-EL = 6.82 = 8.49 ± 0.6025, with MS-NC-EL = 6.82 = 9.21 ± 0.66). The anxiety levels significantly decreased 4 months after CGT (third session) in mothers of p.R337H carriers. We did not find a significant change in depression scores. Mothers with mental health instability requiring medications need periodical psychological support during and after CGT.
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Golinghorst D, de Paor A, Joly Y, Macdonald AS, Otlowski M, Peter R, Prince AER. Anti-Selection & Genetic Testing in Insurance: An Interdisciplinary Perspective. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:139-154. [PMID: 35243989 DOI: 10.1017/jme.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Anti-selection occurs when information asymmetry exists between insurers and applicants. When an applicant knows they are at high risk of loss, but the insurer does not, the applicant may try to use this knowledge differential to secure insurance at a lower premium that does not match risk.
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Making Sense of a Health Threat: Illness Representations, Coping, and Psychological Distress among BRCA1/2 Mutation Carriers. Genes (Basel) 2021; 12:genes12050741. [PMID: 34069035 PMCID: PMC8156260 DOI: 10.3390/genes12050741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Little is known about how women with a BRCA1/2 mutation develop an individual understanding of their breast and ovarian cancer risk and how this affects their psychological distress. In this study, we investigated associations between illness representations, coping strategies and psychological distress. N = 101 BRCA1/2 mutation carriers answered self-report questionnaires on illness representations, coping strategies, cancer worry and depressive symptoms. Women without cancer were compared to women with a previous cancer diagnosis. Illness representations explained 50% and 45% of the variability in cancer worry and depressive symptoms, respectively. Woman perceiving severe consequences (β = 0.29, p < 0.01) and having more concerns (β = 0.37, p < 0.01) were found to report more cancer worry. Perceiving information about the mutation as less coherent (β = −0.17, p < 0.05) and experiencing negative emotional responses (β = 0.60, p < 0.01) were both associated with more depressive symptoms. Women with a previous cancer diagnosis show patterns of illness representations that are potentially more distressing than women without a cancer diagnosis. Findings suggest that physicians involved in counseling should pay attention to illness representations of distressed women. Thereby, it would be possible to detect maladaptive thoughts associated with the mutation, address negative emotions and encourage adaptive coping strategies.
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Butler E, Collier S, Boland M, Hanhauser Y, Connolly E, Hevey D. Self-concept and health anxiety relate to psychological outcomes for BRCA1/2 carriers. Psychooncology 2020; 29:1638-1645. [PMID: 33463858 DOI: 10.1002/pon.5483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Leventhal's common sense model of self-regulation highlights how specific beliefs about illness influence psychological outcomes. Little is known on how such beliefs relate to BRCA1/2 adjustment. Furthermore, beliefs about one's self-concept may be relevant to genetic conditions and may relate to psychological wellbeing. METHODS One-hundred and eighteen female BRCA1/2 carriers from an Irish University Hospital completed questionnaires for this cross-sectional study. Outcomes measured were state anxiety and physical and mental health-related quality of life (HRQOL). Explanatory variables included sociodemographics, health anxiety, illness perceptions, coping and self-concept. Hierarchical multiple regression analyses were conducted. RESULTS Then, 44% of participants had clinically significant state anxiety and 12% had clinically significant health anxiety. Vulnerability, stigma, mastery and health anxiety explained 42% of the variance in state anxiety. Previous mental health difficulty, vulnerability, stigma, mastery and health anxiety explained 40% of the variance in mental HRQOL. Dysfunctional coping strategies were strongly related to the physical functioning aspect of quality of life. CONCLUSION BRCA-specific beliefs related to self and health anxiety are important factors to consider in the adjustment to BRCA1/2 confirmation.
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Affiliation(s)
- Ellen Butler
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sonya Collier
- Department of Psychological Medicine, St. James's Hospital, Dublin, Ireland
| | - Michael Boland
- Department of Breast Surgery, St. James's Hospital, Dublin, Ireland
| | - Yvonne Hanhauser
- Department of Breast Surgery, St. James's Hospital, Dublin, Ireland
| | | | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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Vornanen M, Aktan-Collan K, Hallowell N, Konttinen H, Haukkala A. Lay Perspectives on Receiving Different Types of Genomic Secondary Findings: a Qualitative Vignette Study. J Genet Couns 2018; 28:343-354. [DOI: 10.1007/s10897-018-0288-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M. Vornanen
- Department of Social Research; University of Helsinki; Unioninkatu 37 P.O. Box 54 00014 Helsinki Finland
| | - K. Aktan-Collan
- Department of Social Research; University of Helsinki; Unioninkatu 37 P.O. Box 54 00014 Helsinki Finland
| | - N. Hallowell
- Big Data Institute and the Ethox Centre; Nuffield Department of Population Health; University of Oxford; Oxford UK
| | - H. Konttinen
- Department of Food and Nutrition; University of Helsinki; Helsinki Finland
| | - A. Haukkala
- Department of Social Research; University of Helsinki; Unioninkatu 37 P.O. Box 54 00014 Helsinki Finland
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Postolica R, Iorga M, Savin M, Azoicai D, Enea V. The utility of Leventhal's model in the analysis of the psycho-behavioral implications of familial cancer - a literature review. Arch Med Sci 2018; 14:1144-1154. [PMID: 30154899 PMCID: PMC6111358 DOI: 10.5114/aoms.2016.63149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/01/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We aim to highlight the utility of this model in the analysis of the psycho-behavioral implications of family cancer, presenting the scientific literature that used Leventhal's model as the theoretical framework of approach. MATERIAL AND METHODS A systematic search was performed in six databases (EBSCO, ScienceDirect, PubMed Central, ProQuest, Scopus, and Web of Science) with empirical studies published between 2006 and 2015 in English with regard to the Common Sense Model of Self-Regulation (CSMR) and familial/hereditary cancer. The key words used were: illness representations, common sense model, self regulatory model, familial/hereditary/genetic cancer, genetic cancer counseling. The selection of studies followed the PRISMA-P guidelines (Moher et al., 2009; Shamseer et al., 2015), which suggest a three-stage procedure. RESULTS Individuals create their own cognitive and emotional representation of the disease when their health is threatened, being influenced by the presence of a family history of cancer, causing them to adopt or not a salutogenetic behavior. Disease representations, particularly the cognitive ones, can be predictors of responses to health threats that determine different health behaviors. Age, family history of cancer, and worrying about the disease are factors associated with undergoing screening. No consensus has been reached as to which factors act as predictors of compliance with cancer screening programs. CONCLUSIONS This model can generate interventions that are conceptually clear as well as useful in regulating the individuals' behaviors by reducing the risk of developing the disease and by managing as favorably as possible health and/or disease.
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Affiliation(s)
- Roxana Postolica
- Institute of Oncology, Iasi, Romania
- Department of Oncogenetics, University of Medicine and Pharmacy “Gr. T. Popa” of Iasi, Iasi, Romania
| | - Magdalena Iorga
- University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Iasi, Romania
| | - Mihaela Savin
- Department of Psychology, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Doina Azoicai
- Department of Oncogenetics, University of Medicine and Pharmacy “Gr. T. Popa” of Iasi, Iasi, Romania
| | - Violeta Enea
- Faculty of Psychology and Education Sciences, University “Alexandru Ioan Cuza” of Iasi, Iasi, Romania
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Vicuña B, Delaney HD, Flores KG, Ballinger L, Royce M, Dayao Z, Pal T, Kinney AY. Preferences for multigene panel testing for hereditary breast cancer risk among ethnically diverse BRCA-uninformative families. J Community Genet 2018; 9:81-92. [PMID: 28971318 PMCID: PMC5752653 DOI: 10.1007/s12687-017-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022] Open
Abstract
Until recently, genetic testing for hereditary breast cancer has primarily focused on pathogenic variants in the BRCA1 and BRCA2 (BRCA) genes. However, advances in DNA sequencing technologies have made simultaneous testing for multiple genes possible. We examined correlates of interest in multigene panel testing and risk communication preferences in an ethnically diverse sample of women who tested negative for BRCA mutations previously but remain at high risk based on their family history (referred to as "BRCA-uninformative") and their at-risk female family members. Two-hundred and thirteen women with a previous breast cancer diagnosis and a BRCA-uninformative test result and their first-degree relatives completed a survey on interest in multigene panel testing, communication preferences, and sociodemographic, psychological, and clinical factors. Stepwise logistic regression was used to identify factors associated with testing interest. Chi-square analyses were used to test differences in risk communication preferences. Interest in multigene panel testing was high (84%) and did not considerably differ by cancer status or ethnicity. In multivariable analysis, factors significantly associated with interest in genetic testing were having had a mammogram in the past 2 years (odds ratio (OR) = 4.04, 95% confidence interval (CI) 1.80-9.02) and high cancer worry (OR = 3.77, 95% CI 1.34-10.60). Overall, the most commonly preferred genetic communication modes were genetic counselors, oncologists, and print materials. However, non-Hispanic women were more likely than Hispanic women to prefer web-based risk communication (p < 0.001). Hispanic and non-Hispanic women from BRCA-uninformative families have a high level of interest in gene panel testing. Cancer-related emotions and communication preferences should be considered in developing targeted genetic risk communication strategies.
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Affiliation(s)
- Belinda Vicuña
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA
| | - Harold D Delaney
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kristina G Flores
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Lori Ballinger
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Melanie Royce
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Zoneddy Dayao
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Anita Y Kinney
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA.
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA.
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
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Paquet L, Simmonds L, Yang C, Verma S. An exploratory study of patients' views about being at high-risk for breast cancer and risk management beliefs and intentions, before and after risk counselling: Preliminary evidence of the influence of beliefs on post-counselling prevention intentions. PATIENT EDUCATION AND COUNSELING 2017; 100:575-582. [PMID: 27756584 DOI: 10.1016/j.pec.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/24/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) To describe how women at high-risk for breast cancer (BC) perceive their at-risk status and the options available to manage this risk, before and after risk counselling; 2) to explore the contributions of pre-counselling demographic, clinical, cognitive and emotional factors to post-counselling risk management intentions. METHODS 58 of 173 eligible patients (34%) enrolled and were asked to fill surveys including measures of 1) subjective risk, 2) illness (being at high-risk for BC) and 3) treatment (surveillance, lifestyle modifications, and chemoprevention) cognitions, 4) BC fear and 5) future risk management intentions, prior to and 3 months after risk consultation. RESULTS 48 of 58 participants (83%) completed both surveys. Beliefs and emotions about their condition and its management were stable over time. Surveillance and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than chemoprevention (all ps <0.001). The strongest predictors of intentions strengths were the women's beliefs about the risk reduction methods, especially for lifestyle and chemoprevention (all ps <0.01). CONCLUSIONS The findings emphasize the importance of patients' beliefs in risk management decisions. PRACTICAL IMPLICATIONS Patients' treatment beliefs appear to influence their choice of BC risk reduction strategies and should be discussed during risk reduction consultations.
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Affiliation(s)
- Lise Paquet
- Department of Psychology, Carleton University, Ottawa K1S 5B6, Canada.
| | - Lisa Simmonds
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Charles Yang
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Shailendra Verma
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
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Solomon I, Harrington E, Hooker G, Erby L, Axilbund J, Hampel H, Semotiuk K, Blanco A, Klein WMP, Giardiello F, Leonard L. Lynch Syndrome Limbo: Patient Understanding of Variants of Uncertain Significance. J Genet Couns 2017; 26:866-877. [PMID: 28127677 DOI: 10.1007/s10897-017-0066-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/01/2017] [Indexed: 01/20/2023]
Abstract
Providers and patients encounter challenges related to the management of Variants of Unknown Significance (VUS). A VUS introduces new counseling dilemmas for the understanding and psychosocial impact of uncertain genetic test results. This descriptive study uses Mishel's theory of uncertainty in illness to explore the experience of individuals who have received a VUS as part of the genetic testing process. Semi-structured interviews were conducted with 27 adult individuals who received a VUS for Lynch syndrome mismatch repair genes between 2002 and 2013. The interviews were transcribed and analyzed. Most individuals recalled their result and perceived various types of uncertainty associated with their VUS. Half of the participants appraised their variant as a danger and implemented coping strategies to reduce the threat of developing cancer. Mobilizing strategies to reduce their risk included vigilant cancer surveillance, information seeking and notifying relatives. The majority of participants were unaware of the possibility of a VUS before receiving their result and expected reclassification over time. These results provide insight into the ways healthcare providers can support patients who receive VUS for Lynch syndrome. Findings also provide direction for future work that can further explicate the impact of receiving a VUS.
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Affiliation(s)
- Ilana Solomon
- City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA.
| | | | | | - Lori Erby
- National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | | | - Heather Hampel
- The Ohio State University Comprehensive Cancer Institute, Columbus, OH, USA
| | - Kara Semotiuk
- Mount Sinai Hospital Zane Cohen Centre for Digestive Diseases, Toronto, ON, Canada
| | - Amie Blanco
- University of California San Francisco Helen Diller Family Comprehensive Cancer Treatment Center, San Francisco, CA, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | | | - Lori Leonard
- Department of Development Sociology, Cornell University, New York, NY, USA
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11
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Engagement and communication among participants in the ClinSeq Genomic Sequencing Study. Genet Med 2016; 19:98-103. [PMID: 27763633 DOI: 10.1038/gim.2016.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/21/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE As clinical genome sequencing expand its reach, understanding how individuals engage with this process are of critical importance. In this study, we aimed to describe internal engagement and its correlates among a ClinSeq cohort of adults consented to genome sequencing and receipt of results. METHODS This study was framed using the precaution adoption process model (PAPM), in which knowledge predicts engagement and engagement predicts subsequent behaviors. Prior to receipt of sequencing results, 630 participants in the study completed a baseline survey. Engagement was assessed as the frequency with which participants thought about their participation in ClinSeq since enrollment. RESULTS Results were consistent with the PAPM: those with higher genomics knowledge reported higher engagement (r = 0.13, P = 0.001) and those who were more engaged reported more frequent communication with their physicians (r = 0.28, P < 0.001) and family members (r = 0.35, P < 0.001) about ClinSeq. Characteristics of those with higher engagement included poorer overall health (r = -0.13, P = 0.002), greater seeking of health information (r = 0.16, P < 0.001), and more recent study enrollment (r = -0.21, P < 0.001). CONCLUSION These data support the importance of internal engagement in communication related to genomic sequencing.Genet Med 19 1, 98-103.
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12
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Eriksson LE, Fritzell K, Rixon L, Björk J, Wettergren L. The role of illness perceptions in adherence to surveillance in patients with familial adenomatous polyposis (FAP). Psychooncology 2015; 25:699-706. [PMID: 26425823 DOI: 10.1002/pon.3997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the study was to examine patients' beliefs about having familial adenomatous polyposis (FAP), a hereditary colorectal cancer syndrome, and how these beliefs are associated with adherence to endoscopic surveillance. METHODS Adult patients diagnosed with FAP on the national Swedish polyposis register who had undergone prophylactic colorectal surgery (n 209, response rate 76%) completed the Illness Perception Questionnaire (IPQ). Logistic regression analysis was used to investigate the relationships between illness perceptions and adherence, when controlling for demographic and clinical factors. RESULTS FAP was less distressing in men and those with fewer symptoms, reporting less serious consequences and more coherent understanding of FAP. Non-adherence (14%) to surveillance was associated with being older, having undergone surgery less recently and no history of malignancy. Patients' beliefs about their FAP were able to explain unique variance in non-adherence, in particular those who believed FAP was less distressing. CONCLUSIONS Patients who were non-adherent to endoscopic surveillance had more positive perceptions about their FAP and, in particular, were less emotionally affected compared to those who adhered. As non-adherence implies a greater risk of future malignancies, special efforts are required to effectively prevent cancer in all patients with FAP. Those who have lived with the condition for a long time, and are not troubled by gastrointestinal symptoms or worried about their FAP, may be in need of specific information and support. Further prospective research is required to examine emotional predictors and consequences of non-adherence. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,School of Health Sciences, City University London, London, United Kingdom
| | - Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,The Swedish Polyposis Registry, Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lorna Rixon
- School of Health Sciences, City University London, London, United Kingdom
| | - Jan Björk
- The Swedish Polyposis Registry, Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Taber JM, Aspinwall LG, Stump TK, Kohlmann W, Champine M, Leachman SA. Genetic test reporting enhances understanding of risk information and acceptance of prevention recommendations compared to family history-based counseling alone. J Behav Med 2015; 38:740-53. [PMID: 26178773 PMCID: PMC4568160 DOI: 10.1007/s10865-015-9648-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 05/15/2015] [Indexed: 11/25/2022]
Abstract
It is unknown whether or why genetic test reporting confers benefits in the understanding and management of cancer risk beyond what patients learn from counseling based on family history. A prospective nonexperimental control group study compared participants from melanoma-prone families who underwent CDKN2A/p16 (p16) genetic testing (27 carriers, 38 noncarriers) to participants from equivalently melanoma-prone families known not to carry a deleterious p16 mutation (31 no-test controls). All participants received equivalent counseling concerning elevated lifetime melanoma risk and corresponding recommendations for prevention and screening. Both immediately and 1 month after counseling, participants receiving a genetic test result reported greater understanding of their risk, decreased derogation of the risk information, and greater personal applicability of prevention recommendations than no-test controls. Decreased derogation of risk information after test reporting predicted further increases in understanding of melanoma risk and applicability of prevention recommendations 1 month later. Results suggest unique benefits of genetic test reporting in promoting understanding and acceptance of information about hereditary cancer risk and its management.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA.
| | - Tammy K Stump
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Hamilton RJ, Innella NA, Bounds DT. The Life Course Perspective: a Guide for Genetic Counselors. J Genet Couns 2015; 25:44-8. [PMID: 26306684 DOI: 10.1007/s10897-015-9878-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
This is the first article in a two part series about utilizing the life course perspective (LCP) in genetic counseling. LCP can be a useful tool for genetic counselors when counseling people with a known genetic mutation. Previous theories such as Protection Motivation Theory (PMT) and Common Sense Model of Self-Regulation (CSMSR) examine current reactions to a positive genetic test result. LCP extends beyond the current time to explore temporal and contextual elements of the experience. A review of research revealed, LCP has been used to study the perspective of caregivers of people with Alzheimer's disease, referral for a family history of breast cancer, Mexican American caregivers of older adult, social class and cancer incidence and cancer and the sense of mastery. Incorporating LCP into a study explaining the experiences of people living with a positive test result for a genetic mutation such as the BRCA mutation provides a comprehensive exploration of this experience.
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Affiliation(s)
- Rebekah J Hamilton
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA.
| | - Nancy A Innella
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
| | - Dawn T Bounds
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
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Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2014; 121:341-60. [PMID: 25234846 DOI: 10.1002/cncr.28879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care.
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Johansson AC, Axelsson M, Berndtsson I, Brink E. Illness perceptions in relation to experiences of contemporary cancer care settings among colorectal cancer survivors and their partners. Int J Qual Stud Health Well-being 2014; 9:23581. [PMID: 25056939 PMCID: PMC4108758 DOI: 10.3402/qhw.v9.23581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 12/20/2022] Open
Abstract
Illness is constituted by subjective experiences of symptoms and their psychosocial consequences. Illness perceptions concern people's lay beliefs about understandings and interpretation of a disease and expectations as to disease outcome. Our knowledge about illness perceptions and coping in relation to the cancer care context among persons with colorectal cancer (CRC) and their partners is incomplete. The aim of the present study was to explore illness perceptions in relation to contemporary cancer care settings among CRC survivors and partners. The present research focused on illness rather than disease, implying that personal experiences are central to the methodology. The grounded theory method used is that presented by Kathy Charmaz. The present results explore illness perceptions in the early recovery phase after being diagnosed and treated for cancer in a contemporary cancer care setting. The core category outlook on the cancer diagnosis when quickly informed, treated, and discharged illustrates the illness perceptions of survivors and partners as well as the environment in which they were found. The cancer care environment is presented in the conceptual category experiencing contemporary cancer care settings. Receiving treatment quickly and without waiting was a positive experience for both partners and survivors; however partners experienced the information as massive and as causing concern. The period after discharge was being marked by uncertainty and loneliness, and partners tended to experience non-continuity in care as more problematic than the survivor did. The results showed different illness perceptions and a mismatch between illness perceptions among survivors and partners, presented in the conceptual category outlook on the cancer diagnosis. One illness perception, here presented among partners, focused on seeing the cancer diagnosis as a permanent life-changing event. The other illness perception, here presented among survivors, concentrated on leaving the cancer diagnosis behind and moving forward. The importance of illness perceptions among survivors, and the differences in illness perceptions between survivors and partners, should be recognized by healthcare professionals to achieve the goals of person-centered contemporary cancer care.
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Affiliation(s)
- Ann-Caroline Johansson
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden;
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Sweden
| | - Ina Berndtsson
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | - Eva Brink
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Sie AS, Prins JB, van Zelst-Stams WAG, Veltman JA, Feenstra I, Hoogerbrugge N. Patient experiences with gene panels based on exome sequencing in clinical diagnostics: high acceptance and low distress. Clin Genet 2014; 87:319-26. [PMID: 24863757 DOI: 10.1111/cge.12433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/08/2014] [Accepted: 05/20/2014] [Indexed: 01/14/2023]
Abstract
The Radboud University Medical Center was among the first to implement two-step exome sequencing in clinical genetic diagnostics. This study is the first to evaluate patient experiences with gene panels based on exome sequencing, using quantified psychological variables: acceptance, psychological distress, expectations of heredity and unsolicited findings. Between August 2011 and July 2012, 177 patients diagnosed with early-onset colorectal/kidney cancer, deafness, blindness or movement disorder consented to diagnostic exome sequencing offered by clinical geneticists. Baseline questionnaires were sent to 141 adults, returned by 111 with median age of 49 [22-79] years and positive family history in 81%. Follow-up included 91 responders at median 4 [2-22] weeks after results from known gene panels per diagnosis group; exome-wide analysis is ongoing. Confirmed or possibly pathogenic mutations were found in 31% with one unsolicited finding (oncogenetic panel). Most patients (92%) were satisfied. There were no significant changes in heredity-specific distress (18% at baseline, 17% at follow-up) and expectations of heredity. Fewer patients expected unsolicited findings at follow-up (29% vs 18%, p = 0.01). Satisfaction and distress were equal in those with vs without mutations. In conclusion, most adults accepted and were satisfied with gene panels based on diagnostic exome sequencing, few reporting distress.
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Affiliation(s)
- A S Sie
- Department of Human Genetics
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18
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Milhabet I, Duprez C, Krzeminski A, Christophe V. Cancer risk comparative perception and overscreening behaviours of non-carriers from BRCA1/2 families. Eur J Cancer Care (Engl) 2013; 22:540-8. [PMID: 23731020 DOI: 10.1111/ecc.12060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2013] [Indexed: 01/12/2023]
Abstract
Cancer-free women who are from families with an inherited form of breast and/or ovarian cancer (BRCA1/2) are referred to as 'unaffected non-carriers' when the results of genetic testing for the inherited gene are negative. Recent studies have identified overscreening behaviours (undergoing more screening tests for cancer than are medically warranted) among these women, even though they do not require specific cancer monitoring. Overscreening behaviours deserve particular attention due to their potential psychological drivers and implications. The principal objective of this study was to examine the factors, including state anxiety, feelings of self-vulnerability, and the comparative perception of cancer risk that might explain these overscreening behaviours. Unaffected non-carriers women (n = 77) were asked about these different variables. Overscreening was associated with and determined by feelings of self-vulnerability and the comparative perception of cancer risk, but was not associated with anxiety. An increase in feelings of self-vulnerability or elevated comparative pessimism (CP) was related to the participants' decision to be frequently screened. Patients' perceptions of the risk should be considered in measures or information aimed at preventing inappropriate overscreening behaviours.
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Affiliation(s)
- I Milhabet
- Laboratoire d'Anthropologie et de Psychologie Cognitives et Sociales, Université de Nice-Sophia Antipolis, Nice Cedex 4, France.
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19
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Watkins KE, Way CY, Gregory DM, LeDrew HM, Ludlow VC, Esplen MJ, Dowden JJ, Cox JE, Fitzgerald GWN, Parfrey PS. Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale. BMC Psychol 2013; 1:7. [PMID: 25566359 PMCID: PMC4270033 DOI: 10.1186/2050-7283-1-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/06/2013] [Indexed: 11/20/2022] Open
Abstract
Background The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments. Furthermore, we have limited insight into the role of the family in promoting adjustment. Methods The purpose of this study was to develop and initially validate the Psychosocial Adjustment to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated from a qualitative data base and tested in a sample of 243 participants from families with LS. Results The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the psychometric properties of the PAHD. The findings support the convergent and discriminant validity of the subscales. Construct validity was confirmed by factor analysis and Cronbach’s alpha supported a strong internal consistency for BK (0.83) and FC (0.84). Conclusion Preliminary testing suggests that the PAHD is a psychometrically sound scale capable of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable monitoring tool to identify individuals and families who may require therapeutic interventions.
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Affiliation(s)
- Kathy E Watkins
- Centre for Nursing Studies, Eastern Regional Integrated Health Authority, St. John's, NL Canada ; Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Christine Y Way
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; School of Nursing, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; Eastern Regional Integrated Health Authority, St. John's, NL Canada
| | - Holly M LeDrew
- Western Regional School of Nursing, Western Regional Integrated Health Authority, Corner Brook, NL Canada
| | - Valerie C Ludlow
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Jeffrey J Dowden
- Newfoundland and Labrador Centre for Health Information, St. John's, NL Canada
| | - Janet E Cox
- Division of Surgery, Charles S. Curtis Memorial Hospital, St. Anthony, NL Canada
| | | | - Patrick S Parfrey
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
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20
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Ayode D, McBride CM, de Heer H, Watanabe E, Gebreyesus T, Tadele G, Tora A, Davey G. The association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by podoconiosis in rural Ethiopia. Am J Trop Med Hyg 2012; 87:623-30. [PMID: 22826482 DOI: 10.4269/ajtmh.2012.12-0204] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Little is known about how beliefs about heredity as a cause of health conditions might influence preventive and interpersonal behaviors among those individuals with low genetic and health literacy. We explored causal beliefs about podoconiosis, a neglected tropical disease (NTD) endemic in Ethiopia. Podoconiosis clusters in families but can be prevented if individuals at genetically high risk wear shoes consistently. Adults (N = 242) from four rural Ethiopian communities participated in qualitative assessments of beliefs about the causes of podoconiosis. Heredity was commonly mentioned, with heredity being perceived as (1) the sole cause of podoconiosis, (2) not a causal factor, or (3) one of multiple causes. These beliefs influenced the perceived controllability of podoconiosis and in turn, whether individuals endorsed preventive and interpersonal stigmatizing behaviors. Culturally informed education programs that increase the perceived controllability of stigmatized hereditary health conditions like podoconiosis have promise for increasing preventive behaviors and reducing interpersonal stigma.
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Affiliation(s)
- Desta Ayode
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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21
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den Heijer M, Seynaeve C, Vanheusden K, Timman R, Duivenvoorden HJ, Tilanus-Linthorst M, Menke-Pluijmers MBE, Tibben A. Long-term psychological distress in women at risk for hereditary breast cancer adhering to regular surveillance: a risk profile. Psychooncology 2012; 22:598-604. [DOI: 10.1002/pon.3039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 11/16/2011] [Accepted: 01/07/2012] [Indexed: 11/06/2022]
Affiliation(s)
| | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology; Erasmus MC-Daniel den Hoed Cancer Center; Rotterdam; The Netherlands
| | | | - Reinier Timman
- Department of Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam; The Netherlands
| | - Hugo J Duivenvoorden
- Department of Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam; The Netherlands
| | - Madeleine Tilanus-Linthorst
- Family Cancer Clinic, Department of Surgical Oncology; Erasmus MC-Daniel den Hoed Cancer Center; Rotterdam; The Netherlands
| | - Marian BE Menke-Pluijmers
- Family Cancer Clinic, Department of Surgical Oncology; Erasmus MC-Daniel den Hoed Cancer Center; Rotterdam; The Netherlands
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22
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Vos J, Oosterwijk JC, Gomez-Garcia E, Menko FH, Collee MJ, van Asperen CJ, Jansen AM, Stiggelbout AM, Tibben A. Exploring the short-term impact of DNA-testing in breast cancer patients: the counselees' perception matters, but the actual BRCA1/2 result does not. PATIENT EDUCATION AND COUNSELING 2012; 86:239-251. [PMID: 21684708 DOI: 10.1016/j.pec.2011.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 03/11/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Previous studies suggest that learning a DNA-test-result has no direct impact on the medical-decisions and psychological well-being of counselees. Their perception, especially their recollections and interpretations of their cancer-risks and heredity, predict and/or mediate this impact. These studies were criticized for their small range of predictors, mediators, outcomes and contextual factors. We studied the short-term impact of DNA-testing with an extended model. METHODS Three months after disclosure of BRCA1/2-test-results, we sent counselees a questionnaire about their perception, medical and psychological outcomes, and medical, familial and psychological contexts. 248 affected women participated; 30 had received pathogenic-mutations, 16 unclassified-variants and 202 uninformative-results. RESULTS The actually communicated genetic-information and the contextual variables predicted the counselees' perception, but did not directly predict any outcomes. The counselees' perception predicted and/or completely mediated the counselees' medical intentions and behavior, physical and psychological life-changes, stigma, mastery, negativity and cancer-worries. Short-term distress was related to the perception not only of their own risks, but also of their relatives' risks and heredity-likelihood. Effect sizes were medium to large. CONCLUSIONS AND IMPLICATIONS The outcomes of DNA-testing were better predicted by the counselees' perception than by the actually given genetic-information. We recommend genetic-counselors to have tailored, interactive dialogues about the counselees' perception.
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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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23
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Shiloh S, Dagan E, Friedman I, Blank N, Friedman E. A follow-up study on men tested for BRCA1/BRCA2 mutations: impacts and coping processes. Psychooncology 2011; 22:417-25. [DOI: 10.1002/pon.2106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Irit Friedman
- Susanne Levy Gertner Oncogenetics Unit; Sheba Medical Center; Ramat Gan; Israel
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24
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Katapodi MC, Northouse L, Pierce P, Milliron KJ, Liu G, Merajver SD. Differences Between Women Who Pursued Genetic Testing for Hereditary Breast and Ovarian Cancer and Their At-Risk Relatives Who Did Not. Oncol Nurs Forum 2011; 38:572-81. [DOI: 10.1188/11.onf.572-581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Landsbergen KM, Prins JB, Brunner HG, Hoogerbrugge N. Shortened time interval between colorectal cancer diagnosis and risk testing for hereditary colorectal cancer is not related to higher psychological distress. Fam Cancer 2011; 10:51-7. [PMID: 20853153 PMCID: PMC3036824 DOI: 10.1007/s10689-010-9387-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Current diagnostic practices have shortened the interval between colorectal cancer (CRC) diagnosis and genetic analysis for Lynch syndrome by MSI-testing. We studied the relation of time between MSI-testing since CRC diagnosis (MSI-CRC interval) and psychological distress. We performed a cross-sectional study in 89 patients who had previously been treated for CRC. Data were collected during MSI-testing after genetic counseling. Psychological distress was measured with the IES, the SCL-90 and the POMS; social issues with the ISS, ISB and the ODHCF. The median time of MSI-CRC interval was 24 months (range 0-332), with 23% of the patients diagnosed less than 12 months and 42% more than 36 months prior to MSI-testing. In 34% of the patients cancer specific distress was high (IES scores >26). Mean psychopathology (SCL-90) scores were low, mean mood states (POMS) scores were moderate. Interval MSI-CRC was not related to psychological distress. High cancer specific distress was reported by 24% of patients diagnosed with CRC less than 12 months ago versus 39 and 35% by those diagnosed between 12 and 36 months and more than 36 months ago respectively. Distress was positively related to female gender (P = 0.04), religiousness (P = 0.01), low social support (P = 0.02) and difficulties with family communication (P < 0.001). Shortened time interval between CRC diagnosis and MSI-testing is not associated with higher psychological distress. Females, religious persons, those having low social support and those reporting difficulties communicating hereditary colorectal cancer with relatives are at higher risk for psychological distress.
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Affiliation(s)
- K M Landsbergen
- Department of Human Genetics, Raboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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26
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Vos J, Oosterwijk JC, Gómez-García E, Menko FH, Jansen AM, Stoel RD, van Asperen CJ, Tibben A, Stiggelbout AM. Perceiving cancer-risks and heredity-likelihood in genetic-counseling: how counselees recall and interpret BRCA 1/2-test results. Clin Genet 2010; 79:207-18. [DOI: 10.1111/j.1399-0004.2010.01581.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Vos J, Gómez-García E, Oosterwijk JC, Menko FH, Stoel RD, van Asperen CJ, Jansen AM, Stiggelbout AM, Tibben A. Opening the psychological black box in genetic counseling. The psychological impact of DNA testing is predicted by the counselees' perception, the medical impact by the pathogenic or uninformative BRCA1/2-result. Psychooncology 2010; 21:29-42. [DOI: 10.1002/pon.1864] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/22/2010] [Accepted: 09/04/2010] [Indexed: 11/09/2022]
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Claassen L, Henneman L, Kindt I, Marteau TM, Timmermans DR. Perceived Risk and Representations of Cardiovascular Disease and Preventive Behaviour in People Diagnosed with Familial Hypercholesterolemia. J Health Psychol 2010; 15:33-43. [DOI: 10.1177/1359105309345170] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perceived risk and representations of cardiovascular disease (CVD), and preventive behaviour of people diagnosed with Familial Hypercholesterolemia by DNA testing ( N = 81) were assessed. In general, participants perceived their own CVD risk as being relatively low. While participants reported almost optimal medication adherence (99%), only 49 per cent reported following recommendations concerning diet and physical activity. Family history of CVD was associated with both risk perception and the adoption of a healthy lifestyle. In their communications with FH-screened positives, health professionals should be aware that people may underestimate CVD risk, and should stress how behaviour change can reduce the risk.
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Affiliation(s)
- Liesbeth Claassen
- EMGO Institute of Health and Care Research, VU University Medical Center, The Netherlands,
| | - Lidewij Henneman
- EMGO Institute of Health and Care Research, VU University Medical Center, The Netherlands
| | - Iris Kindt
- Foundation for Tracing Hereditary Hypercholesterolemia (StOEH), Amsterdam, The Netherlands
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29
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Glattacker M, Bengel J, Jäckel WH. Die deutschsprachige Version des Illness Perception Questionnaire-Revised. ACTA ACUST UNITED AC 2009. [DOI: 10.1026/0943-8149.17.4.158] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Ziel der Studie war es, die deutschsprachige Version des Illness Perception Questionnaire-Revised (IPQ-R) psychometrisch zu evaluieren. Hierbei wurden die faktorielle Validität, Konstruktvalidität und konkurrente Kriteriumsvalidität bestimmt sowie die interne Konsistenz und Test-Retest-Reliabilität analysiert. Die Mehrzahl der Analysen wurden in einer Querschnittsstudie an N = 817 Patienten aus sechs Rehabilitationskliniken durchgeführt. Die Prüfung der konkurrenten Kriteriumsvalidität erfolgte an einer Teilstichprobe dieser Patienten in Kontrastierung zu einer Stichprobe von N = 58 Akutpatienten. Die Test-Retest-Reliabilität wurde anhand einer Stichprobe von N = 45 Patienten aus zwei Rehabilitationskliniken ermittelt. Die faktorielle Struktur des Original-Fragebogens kann insgesamt bestätigt werden. Die Cronbachs Alpha-Koeffizienten liegen mit Werten zwischen .70 und .87 in einem befriedigend bis guten Bereich, lediglich die Skala „Behandlungskontrolle” weist mit einem α von .58 einen inakzeptablen Wert auf. Das Muster der Korrelationsmatrix ist plausibel. Der Fragebogen diskriminiert zwischen Rehabilitanden und Akutpatienten und weist mit Intraklassenkoeffizienten zwischen .55 und .87 bzw. Pearson-Korrelationskoeffizienten zwischen .56 und .87 eine ausreichende Test-Retest-Reliabilität auf. Die kognitiven Krankheitsrepräsentationen von Rehabilitanden können mit dem deutschsprachigen IPQ-R relativ reliabel und valide gemessen werden. Einige der Ergebnisse weisen jedoch auf Überarbeitungspotenzial des Fragebogens hin.
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Affiliation(s)
- Manuela Glattacker
- Abteilung Qualitätsmanagement und Sozialmedizin, Universitätsklinkum Freiburg
| | - Jürgen Bengel
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg
| | - Wilfried H. Jäckel
- Abteilung Qualitätsmanagement und Sozialmedizin, Universitätsklinkum Freiburg, Hochrhein-Institut für Rehabilitationsforschung und RehaKlinikum, Bad Säckingen
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30
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Moolenburgh SE, Mureau MAM, Versnel SL, Duivenvoorden HJ, Hofer SOP. The impact of nasal reconstruction following tumour resection on psychosocial functioning, a clinical-empirical exploration. Psychooncology 2009; 18:747-52. [PMID: 19061184 DOI: 10.1002/pon.1459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Total or partial nasal amputation following tumour resection is one of the more severe facial disfigurements. Successful nasal reconstruction can therefore be regarded as restoring a patient's psychosocial health. The objective of this study, therefore, was to evaluate different determinants of patient's psychosocial functioning and their effect on patient satisfaction after nasal reconstruction. METHODS A cross-sectional study with a case-control study design was conducted. Level of satisfaction with nasal appearance and psychosocial functioning were assessed with validated questionnaires. RESULTS A total of 30 consecutive patients were recruited. They were treated between November 2001 and May 2005 for (sub)total nasal defects following radical tumour resection. For the control group 99 consented to participate. Social anxiety and avoidance were scored significantly higher within the patient group (p=0.01). Patients cope significantly more passive than controls (p=0.04). Self-esteem levels did not differ significantly between patients and controls (p=0.22). Determinants of satisfaction with nasal reconstruction were self-esteem (p=0.0001), active coping strategy (p=0.001), and passive coping strategy (p=0.0001). CONCLUSION Nasal reconstruction has an impact on psychosocial functioning of nasal reconstruction patients. In addition, self-esteem and coping strategy are important determinants of satisfaction with nasal reconstruction, and should be held in mind when treating a patient.
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Affiliation(s)
- Sanne E Moolenburgh
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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31
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Tops CMJ, Wijnen JT, Hes FJ. Introduction to molecular and clinical genetics of colorectal cancer syndromes. Best Pract Res Clin Gastroenterol 2009; 23:127-46. [PMID: 19414141 DOI: 10.1016/j.bpg.2009.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The understanding of molecular genetics in the field of gastroenterology has rapidly grown over the last two decades. In recent years many genes involved in the disorders of the gastrointestinal (GI) tract such as colorectal cancer (CRC) and inflammatory bowel disease have been identified. The elucidation of the molecular genetics of these diseases made it possible to study the high-penetrance susceptibility genes for disease-causing mutations with direct implications for relatives of affected individuals. The most immediate application of these advances is the opportunity of pre-symptomatic diagnosis in relatives of affected individuals by molecular genetic testing. In this article, the most commonly employed mutation detection procedures; the outcome and use of these tests in clinical practice are discussed. We focus on the three most common hereditary colorectal cancer syndromes (CCS): Lynch syndrome, familial adenomatous polyposis and MUTYH-associated polyposis.
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Affiliation(s)
- Carli M J Tops
- Centre for Human and Clinical Genetics, LUMC, Leiden, P.O. Box 9600, S06, 2300 RC Leiden, The Netherlands.
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32
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Ramsey S, Blough D, McDermott C, Clarke L, Bennett R, Burke W, Newcomb P. Will knowledge of gene-based colorectal cancer disease risk influence quality of life and screening behavior? Findings from a population-based study. Public Health Genomics 2009; 13:1-12. [PMID: 20160979 DOI: 10.1159/000206346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 12/17/2008] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Several gene variants conveying a modestly increased risk for disease have been described for colorectal cancer. Patient acceptance of gene variant testing in clinical practice is not known. We evaluated the potential impact of hypothetical colorectal-cancer-associated gene variant testing on quality of life, health habits and cancer screening behavior. METHODS First-degree relatives of colorectal cancer patients and controls from the Seattle Colorectal Cancer Familial Registry were invited to participate in a web-based survey regarding testing for gene variants associated with colorectal cancer risk. RESULTS 310 relatives and 170 controls completed the questionnaire. Quality of life for the hypothetical carrier state was modestly and nonsignificantly lower than current health after adjustment for sociodemographic and health factors. In the positive test scenario, 30% of respondents expressed willingness to change their diet, 25% to increase exercise, and 43% to start colorectal cancer screening. The proportions willing to modify these habits did not differ between groups. CONCLUSIONS Testing for gene variants associated with colorectal cancer risk may not influence quality of life, but may impact health habits and screening adherence. Changing behaviors as a result of testing may help to reduce cancer incidence and mortality, particularly among those at higher risk for colorectal cancer.
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Affiliation(s)
- Scott Ramsey
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Wash. 98109, USA.
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Abstract
PURPOSE OF REVIEW With rapid advances in genetic testing for disease susceptibility, behavioral medicine faces significant challenges in identifying likely patterns of use, how individuals interpret test results, and psychosocial and health impacts of testing. We review recent research on these psychosocial aspects of genetic testing for disease risk. RECENT FINDINGS Individuals exhibit limited sensitivity in their perceptions of genetic risk information, and mental representations of disease risk appear to guide testing perceptions and behavioral responses. Motivations to undergo testing are complex, and efforts to develop decision aids are underway. Findings on psychological and behavioral impacts of genetic testing vary markedly, with some evidence of minimal or positive effects and other evidence indicating negative consequences that may be undetectable using common measures of general well being. Recent evidence suggests that genetic risk information can motivate health behavior change. Research demonstrates wide-ranging influences of testing on family dynamics, and use of genetic testing with children is of increasing concern. SUMMARY More research is needed to determine how to structure health communications and counseling to motivate informed use, promote positive responses, and optimize behavior change. Given the ramifications of genetic information for families, personalized genomics will demand a shift toward a family-based healthcare model.
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Bjorvatn C, Eide GE, Hanestad BR, Hamang A, Havik OE. Intrusion and avoidance in subjects undergoing genetic investigation and counseling for hereditary cancer. Support Care Cancer 2009; 17:1371-81. [PMID: 19224252 DOI: 10.1007/s00520-009-0594-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 01/27/2009] [Indexed: 11/25/2022]
Abstract
GOALS OF WORK Genetic counseling for hereditary cancer is expected to involve a growing number of individuals in the near future since an increasing number of genetic tests are offered. This study was designed to identify psychosocial variables predicting distress after genetic investigation and genetic counseling (GC) in order to develop new counseling strategies. MATERIALS AND METHODS A prospective multi-site study was undertaken on 214 patients undergoing GC for hereditary cancer to explore the relationships between socio-demographic variables, medical variables, social support, self-efficacy, physical functioning, satisfaction with GC, the level of worry after GC, results of genetic testing, and the course and outcomes of distress. Distress was measured with the Impact of Event Scale, which includes subscales of intrusion and avoidance. Patients completed questionnaires mailed to them before and after GC. MAIN RESULTS The mean level of intrusion and avoidance was moderate, even though one quarter of participants reported a severe level of intrusion at baseline. Subjects with a low level of self-efficacy at baseline and high level of worry immediately after GC seemed to be vulnerable to both intrusion and avoidance. Lower level of intrusion was also associated with having a first-degree relative with cancer, while a lower avoidance level was associated with a higher level of education, having cancer, more social support, and higher satisfaction with GC. CONCLUSIONS In this study, subjects who had lower level of self-efficacy at baseline and a high level of worry immediately after GC seemed to be vulnerable to both intrusion and avoidance in this study.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, 5018 Bergen, Norway.
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Strømsvik N, Råheim M, Oyen N, Gjengedal E. Men in the women's world of hereditary breast and ovarian cancer--a systematic review. Fam Cancer 2009; 8:221-9. [PMID: 19165626 DOI: 10.1007/s10689-009-9232-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 01/02/2009] [Indexed: 12/31/2022]
Abstract
Little is known about men seeking genetic counseling for hereditary breast and ovarian cancer (HBOC). We review the sparse literature on men attending such genetic consultations. Two main themes are identified: the women's influence on the genetic counseling process, and the psychological impact on men. The women in the HBOC families have an influence on the men's decision to request genetic testing, and they take the leading role in communicating genetic information. With respect to psychological impact, the men suffer from grief and fear of developing cancer, and they seem to use avoidance as a coping strategy. Carrier males experience feelings of guilt because they might have passed on a mutation to their children. Non-carriers experience test-related stress if their siblings tested positive. Mutation status may have an impact on reproductive issues. These findings are discussed in light of gender issues and literature concerning men's health behavior. Further studies are needed to provide optimal care for men seeking genetic counseling for hereditary breast and ovarian cancer.
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Affiliation(s)
- Nina Strømsvik
- Center of Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
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Ockhuysen-Vermey CF, Henneman L, van Asperen CJ, Oosterwijk JC, Menko FH, Timmermans DRM. Design of the BRISC study: a multicentre controlled clinical trial to optimize the communication of breast cancer risks in genetic counselling. BMC Cancer 2008; 8:283. [PMID: 18834503 PMCID: PMC2576334 DOI: 10.1186/1471-2407-8-283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 10/03/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding risks is considered to be crucial for informed decision-making. Inaccurate risk perception is a common finding in women with a family history of breast cancer attending genetic counseling. As yet, it is unclear how risks should best be communicated in clinical practice. This study protocol describes the design and methods of the BRISC (Breast cancer RISk Communication) study evaluating the effect of different formats of risk communication on the counsellee's risk perception, psychological well-being and decision-making regarding preventive options for breast cancer. METHODS AND DESIGN The BRISC study is designed as a pre-post-test controlled group intervention trial with repeated measurements using questionnaires. The intervention-an additional risk consultation-consists of one of 5 conditions that differ in the way counsellee's breast cancer risk is communicated: 1) lifetime risk in numerical format (natural frequencies, i.e. X out of 100), 2) lifetime risk in both numerical format and graphical format (population figures), 3) lifetime risk and age-related risk in numerical format, 4) lifetime risk and age-related risk in both numerical format and graphical format, and 5) lifetime risk in percentages. Condition 6 is the control condition in which no intervention is given (usual care). Participants are unaffected women with a family history of breast cancer attending one of three participating clinical genetic centres in the Netherlands. DISCUSSION The BRISC study allows for an evaluation of the effects of different formats of communicating breast cancer risks to counsellees. The results can be used to optimize risk communication in order to improve informed decision-making among women with a family history of breast cancer. They may also be useful for risk communication in other health-related services. TRIAL REGISTRATION Current Controlled Trials ISRCTN14566836.
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Affiliation(s)
- Caroline F Ockhuysen-Vermey
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands.
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Vos J, Otten W, van Asperen C, Jansen A, Menko F, Tibben A. The counsellees' view of an unclassified variant in BRCA1/2: recall, interpretation, and impact on life. Psychooncology 2008; 17:822-30. [DOI: 10.1002/pon.1311] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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