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Wang C, Bertrand KA, Trevino-Talbot M, Flynn M, Ruderman M, Cabral HJ, Bowen DJ, Hughes-Halbert C, Palmer JR. Ethical, legal, and social implications (ELSI) and challenges in the design of a randomized controlled trial to test the online return of cancer genetic research results to U.S. Black women. Contemp Clin Trials 2023; 132:107309. [PMID: 37516165 PMCID: PMC10544717 DOI: 10.1016/j.cct.2023.107309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/27/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND A central challenge to precision medicine research efforts is the return of genetic research results in a manner that is effective, ethical, and efficient. Formal tests of alternate modalities are needed, particularly for racially marginalized populations that have historically been underserved in this context. METHODS We are conducting a randomized controlled trial (RCT) to test scalable modalities for results return and to examine the clinical utility of returning genetic research results to a research cohort of Black women. The primary aim is to compare the efficacy of two communication modalities for results return: 1) a conventional modality that entails telephone disclosure by a Board-certified genetic counselor, and 2) an online self-guided modality that entails results return directly to participants, with optional genetic counselor follow-up via telephone. The trial is being conducted among participants in the Black Women's Health Study (BWHS), where targeted sequencing of 4000 participants was previously completed. RESULTS Several ethical, legal, and social implications (ELSI) and challenges presented, which necessitated substantial revision of the original study protocol. Challenges included chain of custody, re-testing of research results in a CLIA lab, exclusion of VUS results, and digital literacy. Bioethical principles of autonomy, justice, non-maleficence, and beneficence were considered in the design of the study protocol. CONCLUSION This study is uniquely situated to provide critical evidence on the effectiveness of alternative models for genetic results return and provide further insight into the factors influencing access and uptake of genetic information among U.S. Black women. CLINICALTRIALS gov: NCT04407611.
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Affiliation(s)
- Catharine Wang
- Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, 72 East Concord St, L-7, Boston, MA 02118, USA.
| | | | - Maureen Flynn
- MGH Institute of Health Professions, 36 1st Ave, Boston, MA 02129, USA.
| | - Maggie Ruderman
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, MA 02118, USA.
| | - Howard J Cabral
- Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Deborah J Bowen
- University of Washington, 1959 NE Pacific Street, Box 357120, Seattle, WA 98195, USA.
| | - Chanita Hughes-Halbert
- University of Southern California, 1845 North Soto Street, MC 9C 9239, Los Angeles, CA 90089, USA.
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, 72 East Concord St, L-7, Boston, MA 02118, USA; Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, MA 02118, USA.
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Iwai Y, Toumbou K, Zuze T, Morgan JS, Simwinga L, Wright ST, Fedoriw Y, Oladeru OT, Balogun OD, Roberson ML, Olopade OI, Tomoka T, Elmore SN. Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations. JCO Glob Oncol 2023; 9:e2300154. [PMID: 37944088 PMCID: PMC10645409 DOI: 10.1200/go.23.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts from database inception through 2021 were sourced from PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase, Cochrane Library, and Scopus. Search terms were used to retrieve articles addressing (1) African heritage, (2) breast cancer, and (3) GT or GC. The screening involved abstract and title review and full-text review. Data were extracted for all articles meeting the inclusion criteria. RESULTS A total of 154 studies were included. Most studies that took place were conducted in the United States (71.4%), and most first authors (76.9%) were from the United States. GT was conducted in 73 (49.7%) studies. BRCA1/BRCA2 were the most commonly studied genes for germline mutations. GC was conducted in 49 studies (33.3%), and perspectives on GC were evaluated in 43 (29.3%). The use of racial/ethnic categories varied broadly, although African American was most common (40.1%). Racism was mentioned in three studies (2.0%). CONCLUSION There is a growing body of literature on GT/C for breast cancer in women of African heritage. Future studies on GT/C of African populations should consider increased clarity around racial/ethnic categorizations, continued community engagement, and intentional processes for informed consent.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jenny S. Morgan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Clinical Medicine, Indiana University School of Medicine, Indianapolis, IN
- Department of Global Health, Indiana University School of Medicine, Indianapolis, IN
| | | | - Sarah T. Wright
- UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, FL
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Mya L. Roberson
- Department of Health Policy, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | - Shekinah N.C. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
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George S, Ragin C, Ashing KT. Black Is Diverse: The Untapped Beauty and Benefit of Cancer Genomics and Precision Medicine. JCO Oncol Pract 2021; 17:279-283. [PMID: 33974833 DOI: 10.1200/op.21.00236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sophia George
- University of Miami Miller School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, FL, USA.,African Caribbean Cancer Consortium
| | - Camille Ragin
- African Caribbean Cancer Consortium.,Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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Palmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A, Pawlik TM. Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 2021; 29:7195-7207. [PMID: 34195857 DOI: 10.1007/s00520-021-06382-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping review approach. METHODS Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers. CONCLUSION Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.
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Affiliation(s)
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chelsea Herbert
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alizeh Abbas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Butler E, Collier S, Hevey D. The factors associated with distress a minimum of six months after BRCA1/2 confirmation: A systematic review. J Psychosoc Oncol 2020; 39:646-672. [PMID: 33089755 DOI: 10.1080/07347332.2020.1836109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PROBLEM IDENTIFICATION Many BRCA1/2 carriers experience an increase in distress after diagnosis; however, there is a need to review the longer term psychological implications of genetic confirmation and the factors associated with persistent distress. LITERATURE SEARCH This article systematically reviewed the literature in line with PRISMA guidelines on distress a minimum of six months after BRCA1/2 confirmation focusing on prevalence rates and factors associated with distress. DATA EVALUATION AND SYNTHESIS Fifteen studies were identified for inclusion and a narrative synthesis was conducted. Distress was associated with a range of demographic, clinical and psychological factors. A consistent finding was that although most carriers experience a reduction in distress 6-12 months after BRCA1/2 confirmation, those who experience persistent distress are more likely to have had higher distress levels at time of genetic testing. Risk reducing surgery may also play a role in reducing distress. CONCLUSION The review highlights the importance of psychological assessment and the use of specific distress measures. Given the considerable challenges in synthesizing the data there is a need for further prospective studies of high methodological quality.
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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
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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Southwick SV, Esch R, Gasser R, Cragun D, Redlinger-Grosse K, Marsalis S, Zierhut HA. Racial and ethnic differences in genetic counseling experiences and outcomes in the United States: A systematic review. J Genet Couns 2020; 29:147-165. [PMID: 32144851 DOI: 10.1002/jgc4.1230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
As genetic counseling services expand and reach a wider catchment of the population, there is a critical need to better understand the impact of services on a greater diversity of patients. We conducted a systematic review to evaluate genetic counseling experiences and outcomes among racial and ethnic minorities. Six databases extracted articles published from 2005 to 2019 that assessed genetic counseling participation, knowledge and awareness, motivators, barriers, perceptions, and outcomes for racial and ethnic minority populations in the United States. Genetic counseling outcomes were categorized using the Framework for Outcomes of Clinical commUnication Services. A total of 1,227 abstracts were identified, of which 23 papers met inclusion criteria. Results suggest the possibility of racial and ethnic differences in some genetic counseling experiences and outcomes but noted differences were not adequately replicated between studies. The few included studies differed greatly in aims, methods, and results, which made comparison across study designs challenging and effectively barred thematic analysis. Additional research is needed that includes more study populations and settings with patients of diverse racial and ethnic backgrounds, as well as more structured study designs that allow for elucidations of differences between White and non-White populations.
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Affiliation(s)
- Sabrina V Southwick
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Riley Esch
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Gasser
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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Mighton C, Carlsson L, Clausen M, Casalino S, Shickh S, McCuaig L, Joshi E, Panchal S, Graham T, Aronson M, Piccinin C, Winter-Paquette L, Semotiuk K, Lorentz J, Mancuso T, Ott K, Silberman Y, Elser C, Eisen A, Kim RH, Lerner-Ellis J, Carroll JC, Glogowski E, Schrader K, Bombard Y. Development of patient "profiles" to tailor counseling for incidental genomic sequencing results. Eur J Hum Genet 2019; 27:1008-1017. [PMID: 30846854 PMCID: PMC6777527 DOI: 10.1038/s41431-019-0352-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/12/2018] [Accepted: 01/15/2019] [Indexed: 01/17/2023] Open
Abstract
Guidelines recommend that providers engage patients in shared decision-making about receiving incidental results (IR) prior to genomic sequencing (GS), but this can be time-consuming, given the myriad of IR and variation in patients' preferences. We aimed to develop patient profiles to inform pre-test counseling for IR. We conducted semi-structured interviews with participants as a part of a randomized trial of the GenomicsADvISER.com, a decision aid for selecting IR. Interviews explored factors participants considered when deliberating over learning IR. Interviews were analyzed by thematic analysis and constant comparison. Participants were mostly female (28/31) and about half of them were over the age of 50 (16/31). We identified five patient profiles that reflect common contextual factors, attitudes, concerns, and perceived utility of IR. Information Enthusiasts self-identified as "planners" and valued learning most or all IR to enable planning and disease prevention because "knowledge is power". Concerned Individuals defined themselves as "anxious," and were reluctant to learn IR, anticipating negative psychological impacts from IR. Contemplators were discerning about the value and limitations of IR, weighing health benefits with the impacts of not being able to "un-know" information. Individuals of Advanced Life Stage did not consider IR relevant for themselves and primarily considered their implications for family members. Reassurance Seekers were reassured by previous negative genetic test results which shaped their expectations for receiving no IR: "hopefully [GS will] be negative, too. And then I can rest easy". These profiles could inform targeted counseling for IR by providing a framework to address common values, concerns. and misconceptions.
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Affiliation(s)
- Chloe Mighton
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | | | | | | | - Salma Shickh
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Laura McCuaig
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Esha Joshi
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Seema Panchal
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Tracy Graham
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Melyssa Aronson
- University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | - Laura Winter-Paquette
- University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Kara Semotiuk
- University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | - Talia Mancuso
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen Ott
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Andrea Eisen
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Raymond H Kim
- University Health Network, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Jordan Lerner-Ellis
- University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - June C Carroll
- University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | | | - Yvonne Bombard
- University of Toronto, Toronto, ON, Canada.
- St. Michael's Hospital, Toronto, ON, Canada.
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