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Leader AE, Mercado J, Klein A, Hyatt C, Gross L, Brandt R, Giri VN. Insight into how patients with prostate cancer interpret and communicate genetic test results: implications for families. J Community Genet 2022; 13:547-556. [DOI: 10.1007/s12687-022-00603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
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2
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Schmidlen T, Jones CL, Campbell-Salome G, McCormick CZ, Vanenkevort E, Sturm AC. Use of a chatbot to increase uptake of cascade genetic testing. J Genet Couns 2022; 31:1219-1230. [PMID: 35616645 DOI: 10.1002/jgc4.1592] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 12/18/2022]
Abstract
Successful proband-mediated family communication and subsequent cascade genetic testing uptake requires interventions that present information clearly, in sufficient detail, and with medical authority. To facilitate family communication for patients receiving clinically actionable results via the MyCode® Community Health Initiative, a Family Sharing Tool (FST) and a cascade chatbot were developed. FST is an electronic mechanism allowing patients to share genetic test results with relatives via chatbot. The cascade chatbot describes the proband's result, associated disease risks, and recommended management and captures whether the user is a blood relative or caregiver, sex, and relationship to the proband. FST and cascade chatbot uptake among MyCode® probands and relatives was tracked from August 2018 through February 2020. Cascade genetic testing uptake was collected from testing laboratories as number of cascades per proband. Fifty-eight percent (316/543) of probands consented to FST; 42% (227/543) declined. Receipt preferences were patient electronic health record (EHR) portal (52%), email (29%), and text (19%). Patient EHR portal users (p < 0.001) and younger patients were more likely to consent (p < 0.001). FST was deployed to 308 probands. Fifty-nine percent (183/308) opened; of those, 56% (102/183) used FST to send a cascade chatbot to relatives. These 102 probands shared a cascade chatbot with 377 relatives. Sixty-two percent (235/377) of relatives opened; of these, 69% (161/235) started, and of these, 57% (92/161) completed the cascade chatbot. Cascade genetic testing uptake was significantly greater among relatives of probands who consented to the FST (M = 2.34 cascades, SD = 2.10) than relatives of probands who declined (M = 1.40 cascades, SD = 0.82, p < 0.001). Proband age was not a significant predictor of cascade genetic testing uptake. Further work is needed to better understand factors impacting proband use of FST and relative use of cascade chatbots.
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Affiliation(s)
| | - Claire L Jones
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | | | - Cara Z McCormick
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | - Erin Vanenkevort
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | - Amy C Sturm
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
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3
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Sarki M, Ming C, Aissaoui S, Bürki N, Caiata-Zufferey M, Erlanger TE, Graffeo-Galbiati R, Heinimann K, Heinzelmann-Schwarz V, Monnerat C, Probst-Hensch N, Rabaglio M, Zürrer-Härdi U, Chappuis PO, Katapodi MC. Intention to Inform Relatives, Rates of Cascade Testing, and Preference for Patient-Mediated Communication in Families Concerned with Hereditary Breast and Ovarian Cancer and Lynch Syndrome: The Swiss CASCADE Cohort. Cancers (Basel) 2022; 14:cancers14071636. [PMID: 35406409 PMCID: PMC8997156 DOI: 10.3390/cancers14071636] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022] Open
Abstract
Cascade screening for Tier 1 cancer genetic conditions is a significant public health intervention because it identifies untested relatives of individuals known to carry pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS). The Swiss CASCADE is a family-based, open-ended cohort, including carriers of HBOC- and LS-associated pathogenic variants and their relatives. This paper describes rates of cascade screening in relatives from HBOC- and LS- harboring families, examines carriers' preferences for communication of testing results, and describes theory-based predictors of intention to invite relatives to a cascade screening program. Information has been provided by 304 index cases and 115 relatives recruited from September 2017 to December 2021. On average, 10 relatives per index case were potentially eligible for cascade screening. Approximately 65% of respondents wanted to invite relatives to the cohort, and approximately 50% indicated a preference for patient-mediated communication of testing results, possibly with the assistance of digital technology. Intention to invite relatives was higher for first- compared to second- and third-degree relatives, but was not different between syndromes or based on relatives' gender. The family environment and carrying pathogenic variants predicts intention to invite relatives. Information helps optimize delivery of tailored genetic services.
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Affiliation(s)
- Mahesh Sarki
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
| | - Chang Ming
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
| | - Souria Aissaoui
- Breast Center, Cantonal Hospital Fribourg, 1752 Fribourg, Switzerland;
- GENESUPPORT, The Breast Centre, Hirslanden Clinique de Grangettes, 1224 Geneva, Switzerland
| | - Nicole Bürki
- Women’s Clinic, University Hospital Basel, 4031 Basel, Switzerland; (N.B.); (V.H.-S.)
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | | | | | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland;
- Research Group Human Genomics, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | | | - Christian Monnerat
- Department of Medical Oncology, Hospital of Jura, 2800 Delemont, Switzerland;
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland;
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Ursina Zürrer-Härdi
- Department of Medical Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Pierre Olivier Chappuis
- Unit of Oncogenetics, Division of Oncology, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Division of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
- Correspondence: ; Tel.: +41-61-207-04-30
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4
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Dwyer AA, Hesse-Biber S, Shea H, Zeng Z, Yi S. Coping response and family communication of cancer risk in men harboring a BRCA mutation: A mixed methods study. Psychooncology 2021; 31:486-495. [PMID: 34582073 DOI: 10.1002/pon.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Providing genetic counseling and genetic testing to at-risk blood relatives (cascade screening) is important for improving BRCA cancer outcomes. Intra-familial communication of risk is critical for cascade screening efforts yet relatively little is known about men's role in communicating BRCA risk. We sought to examine men's coping response to their BRCA status and intra-familial communication of risk to inform the development of tailored interventions that could promote cascade screening. METHODS We employed a sequential mixed-methods design. First, we measured coping response (quantitative) using the Multidimensional Impact of Cancer Risk Assessment (MICRA). MICRA scores were compared between BRCA+ men, BRCA- men and BRCA+ women. Subsequently, we used template analysis to analyze qualitative interviews exploring coping and intra-familial communication of risk. The Theory of Planned Behavior (TPB) served as a guiding framework for identifying intervention targets. RESULTS BRCA+ men (n = 36) had significantly higher levels of distress (p < 0.001), uncertainty (p < 0.001) and negative experiences (p < 0.05) compared to BRCA- male counterparts (n = 23). BRCA+ men had significantly lower distress (p < 0.001) and uncertainty (p < 0.001) than BRCA+ women (n = 406). Qualitative analysis of in-depth interviews with BRCA+ men (n = 35) identified promoters and barriers to active coping response and intra-familial communication of risk. Mapping results onto the TPB identified targets for tailoring person-centered approaches for men addressing beliefs/attitude, subjective norms, and perceived behavioral control. CONCLUSIONS Men and women appear to have different coping responses to learning their BRCA status. Developing tailored (sex-based), theory informed interventions may help promote intra-familial communication of BRCA risk and support cascade screening.
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Affiliation(s)
- Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Hannah Shea
- Department of Sociology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Ziwei Zeng
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shiya Yi
- Department of Measurement, Evaluation, Statistics and Assessment, Boston College, Chestnut Hill, Massachusetts, USA
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5
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Barnett M, Breen KE, Kennedy JA, Hernandez M, Matsoukas K, MacGregor M. Psychosocial interventions and needs among individuals and families with Li-Fraumeni syndrome: A scoping review. Clin Genet 2021; 101:161-182. [PMID: 34355387 DOI: 10.1111/cge.14042] [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] [Received: 03/31/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/20/2023]
Abstract
Li-Fraumeni syndrome (LFS), a rare cancer predisposition syndrome caused by germline mutations in the TP53 gene, is associated with significant lifetime risk of developing cancer and warrants extensive and long-term surveillance. There are psychosocial impacts on individuals and families living with this condition, from the initial diagnosis throughout multiple stages across the lifespan, but these impacts have not been systematically reviewed and organized. The objective of this scoping review was to synthesize and characterize the literature on psychosocial screening and outcomes, educational needs, support services, and available interventions for patients and families with LFS. A systematic search of six databases was most recently conducted in August 2020: (PubMed/MEDLINE (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), CINAHL (EBSCO), PsycINFO (OVID), and Web of Science (Clarivate Analytics). A total of 15 757 titles were screened, and 24 articles included. Several important themes were identified across studies: factors associated with TP53 genetic testing, LFS surveillance, psychological outcomes, and communication. Findings related to these themes were organized into age-specific categories (age agnostic/across the lifespan, childhood, adolescence and young adulthood, and adulthood).
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Affiliation(s)
- Marie Barnett
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Kelsey E Breen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Jennifer A Kennedy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Marisol Hernandez
- Medical Library, Memorial Sloan Kettering Cancer Center, New York City, USA.,Medical Library, City University of New York School of Medicine, New York City, USA
| | | | - Meredith MacGregor
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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6
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Dean M, Campbell-Salome G, Rauscher EA. Engaging Men With BRCA-Related Cancer Risks: Practical Advice for BRCA Risk Management From Male Stakeholders. Am J Mens Health 2021; 14:1557988320924932. [PMID: 32449425 PMCID: PMC7249566 DOI: 10.1177/1557988320924932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Men are at risk for developing hereditary cancers such as breast, prostate, pancreatic, and melanoma due to a pathogenic germline variant in either the BRCA1 or BRCA2 gene. The purpose of this study was to identify and provide practical advice for men managing their BRCA-related cancer risks based on men's real-life experiences. Semistructured interviews were conducted with 25 men who either tested positive for a pathogenic variant in BRCA1/2 gene or who had an immediate family member who had tested positive for a pathogenic variant in BRCA1/2. A thematic analysis of the interview transcripts was completed utilizing the constant comparison method. Qualitative analysis produced three categories of participant advice for men who recently learned of their hereditary cancer risk. Specifically, participants advised the following: (a) know the basics, (b) engage in the family narrative, and (c) advocate for yourself. Results showed the need for men to know and understand their BRCA cancer risks and communicate that genetic risk information to their family members and practitioners. In particular, the findings stress the importance of addressing men's risks and medical management from a family-focused approach. Overall, because men are historically undereducated about their BRCA-related cancer risks, this practical advice serves as a first step for men managing BRCA-related cancer risks and may ultimately assist them in making preventive and screening health behaviors.
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Affiliation(s)
- Marleah Dean
- Department of Communication,
Collaborator Member of the Health Outcomes & Behavior Program, Moffitt Cancer
Center, the University of South Florida, Tampa, FL, USA
- Marleah Dean, PhD, Associate Professor,
Department of Communication, Collaborator Member of the Health Outcomes &
Behavior Program, Moffitt Cancer Center, the University of South Florida, 4202
E. Fowler Ave, CIS 1040, Tampa, FL 33620, USA.
| | | | - Emily A. Rauscher
- Department of Communication, Huntsman
Cancer Institute, The University of Utah, Salt Lake City, UT, USA
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7
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Timbs M. Psychosocial factors related to BRCA1/2 disclosures. Nursing 2021; 51:58-61. [PMID: 33759867 DOI: 10.1097/01.nurse.0000733956.47297.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Patients who learn they carry breast cancer genes 1 and 2 (BRCA1/2) must decide if, when, and how they want to disclose this information to family members who may be affected. This article discusses the psychosocial factors that may influence patient decisions to disclose positive BRCA1/2 results to family members, as well as the role of nurses in educating and advocating for patients and their families.
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8
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Peshkin BN, Ladd MK, Isaacs C, Segal H, Jacobs A, Taylor KL, Graves KD, O'Neill SC, Schwartz MD. The Genetic Education for Men (GEM) Trial: Development of Web-Based Education for Untested Men in BRCA1/2-Positive Families. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:72-84. [PMID: 31402434 PMCID: PMC7010546 DOI: 10.1007/s13187-019-01599-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cascade testing for hereditary breast/ovarian cancer is an important public health priority. Increasing attention has been paid to the relevance of testing for men within BRCA1/2-positive families given that such testing may provide important information about their cancer risks, particularly for prostate cancer, and risks to their offspring. However, men are much less likely to seek genetic counseling and testing than their at-risk female relatives. To facilitate access to pre-test information and testing, we developed a web-based intervention (WI) for men that we are evaluating in a pilot randomized controlled trial (RCT). This paper describes three phases of research in the development of the WI: (1) formative (qualitative) research among men from BRCA1/2 families to assess needs and preferences for education; (2) a detailed description of the organization, format, and content of the WI; and (3) usability testing. We discuss the aims and hypotheses of the pilot RCT in which the WI is being compared with an enhanced usual care condition among at-risk men. We expect that the WI described here will foster informed decisions and lead to increased use of BRCA1/2 counseling and testing, potentially yielding improved cancer control outcomes for this understudied group, and for their at-risk relatives.
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Affiliation(s)
- Beth N Peshkin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Mary Kate Ladd
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Hannah Segal
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Aryana Jacobs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Kathryn L Taylor
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Suzanne C O'Neill
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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9
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Barriers and facilitators for cascade testing in genetic conditions: a systematic review. Eur J Hum Genet 2020; 28:1631-1644. [PMID: 32948847 DOI: 10.1038/s41431-020-00725-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022] Open
Abstract
Cascade testing is the process of offering genetic counseling and testing to at-risk relatives of an individual who has been diagnosed with a genetic condition. It is critical for increasing the identification rates of individuals with these conditions and the uptake of appropriate preventive health services. The process of cascade testing is highly varied in clinical practice, and a comprehensive understanding of factors that hinder or enhance its implementation is necessary to improve this process. We conducted a systematic review to identify barriers and facilitators for cascade testing and searched PubMed, CINAHL via EBSCO, Web of Science, EMBASE, and the Cochrane Library for articles published from the databases' inception to November 2018. Thirty articles met inclusion criteria. Barriers and facilitators identified from these studies at the individual-level were organized into the following categories: (1) demographics, (2) knowledge, (3) attitudes, beliefs, and emotional responses of the individual, and (4) perceptions of relatives, relatives' responses, and attitudes toward relatives. At the interpersonal-level, barriers and facilitators were categorized as (1) family communication-, support- and dynamics-, and (2) provider-factors. Finally, barriers at the environmental-level relating to accessibility of genetic services were also identified. Our findings suggest that several individual, interpersonal and environmental factors may play a role in cascade testing. Future studies to further investigate these barriers and facilitators are needed to inform future interventions for improving the implementation of cascade testing for genetic conditions in clinical practice.
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10
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Abstract
PURPOSE OF REVIEW With the increasing use of precision medicine in oncology, genetic counseling and germline genetic testing are becoming increasingly important in urologic malignancies. In this review, we summarize the most relevant recent literature regarding genetic counseling in prostate and kidney cancers. RECENT FINDINGS Genetic counseling and testing is considered as an important component of workup for many patients with urologic malignancies but is likely underutilized. Genetic counseling in prostate cancer is a timely topic, especially as the demand for genetic counselors in oncology continues to increase with expanding guidelines for consideration of genetic testing. Genetic testing has historically been limited to only those with the most suspicious histories, but emerging data from larger studies indicates that the clinical presentation of inherited cancer syndromes are broader than previously appreciated. New models need to be developed for pretest counseling to meet increased demand. SUMMARY Genetic counseling and testing will become increasingly important for patients with urologic malignancies. There is limited literature on this topic, especially related to kidney cancers. Further studies are needed to determine the best way to incorporate genetic counseling and testing into the care of these patients.
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11
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Rauscher EA, Dean M, Campbell-Salome G, Barbour JB. "How do we rally around the one who was positive?" Familial uncertainty management in the context of men managing BRCA-related cancer risks. Soc Sci Med 2019; 242:112592. [PMID: 31629161 DOI: 10.1016/j.socscimed.2019.112592] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE Men with BRCA-related cancer risks face increased disease risk as well as the prospect of passing on their risk to children. OBJECTIVE This study investigates men's communicative appraisal and management of uncertainty related to BRCA-related cancer risks and decision-making. METHODS Guided by uncertainty management theory (UMT), a directed content analysis approach was utilized to analyze interviews with 25 men who either carry a pathogenic BRCA variant or have a 50% chance of carrying a variant but have not yet been tested. RESULTS Participants appraised their individual uncertainty as irrelevant or dangerous but appraised their familial uncertainty as dangerous. Men appraising their uncertainty as a danger exhibited more proactive information seeking healthcare behaviors-such as genetic testing and following recommended screenings-than men who appraised their uncertainty as irrelevant. Participants appraised familial uncertainty as a danger and were engaged in information management with family members, as well as encouraging family members to engage in proactive healthcare decision-making. CONCLUSIONS Men with BRCA-related cancer risks lack understanding about their risks and how to manage them. Increased attention should be paid to the development of interventions tailored specifically to men. Further, interventions focusing on strategically developing proactive family communication behaviors would also be beneficial to men and their families.
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Affiliation(s)
- Emily A Rauscher
- Department of Communication, University of Utah, 255 S Central Campus Dr, Salt Lake City, UT, 84112, USA.
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 E. Fowler Ave, Tampa, FL, 33620, USA.
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Geisinger, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Joshua B Barbour
- Department of Communication, University of Texas, Austin, 2504A Whitis Ave. (A1105), Austin, TX, 78712-0115, USA.
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12
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Young AL, Butow PN, Tucker KM, Williams R, Healey E, Wakefield CE. Health professional and at-risk BRCA young adult perspectives about information needs: What does Gen Y need to know? J Genet Couns 2019; 28:1154-1165. [PMID: 31538377 DOI: 10.1002/jgc4.1167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
Young adults at risk of a hereditary condition require the provision of accurate information to make an informed decision about genetic testing and risk management options. At-risk young adults' (18- to 40-year olds) preferences for information and resources, and genetic-related health professionals' (GHPs) views on young adults' information needs, are largely unknown in the literature. This study aimed to clarify and compare the information needs of emerging (18- to 25-year olds) and early (26- to 40-year olds) adults. Resource preferences of young adults were also explored. Findings are drawn from two datasets: questionnaires and semi-structured interviews with at-risk young adults from BRCA1 or BRCA2 families (N = 32), and focus groups with GHPs (N = 73) working in Australian familial cancer clinics. Both datasets were analyzed using framework analysis. Emerging adults, particularly those who had not attended a clinic, wanted to know the rationale for genetic testing and basic genetic facts. Early adults were concerned about reproductive issues and cancer risk for future or current children. Information needs reported by young adults but not reported by GHPs include male cancer risk, finding reputable information, understanding test results (e.g., negative), and understanding risk terminology (e.g., lifetime cancer risk). Young adults' satisfaction with current information received was suboptimal, yet uptake of genetic-related resources was generally low. Getting information to this cohort remains a challenge for GHPs. Emerging adults showed a preference to obtain information through technologically-based formats (e.g., websites, social media), whereas early adults used a wider range of formats (e.g., websites, booklets). Awareness of and access to genetic information prior to genetic clinic attendance is needed. A review of the utility of current resources available for at-risk young adults would be helpful.
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Affiliation(s)
- Alison Luk Young
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Phyllis N Butow
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Claire E Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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13
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Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
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"I Am Uncertain About What My Uncertainty Even Is": Men's Uncertainty and Information Management of Their BRCA-Related Cancer Risks. J Genet Couns 2018; 27:1417-1427. [PMID: 29971606 DOI: 10.1007/s10897-018-0276-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/21/2018] [Indexed: 12/27/2022]
Abstract
Men with a germline pathogenic BRCA1 or BRCA2 variant have increased risks for developing breast, pancreatic, prostate, and melanoma cancers, but little is known about how they understand and manage their cancer risks. This study examines how men with BRCA-related cancer risks manage uncertainty and information about their risks. Twenty-five men who were either a BRCA carrier or have a BRCA-positive first-degree family member that put the participant at 50% chance of also being a BRCA carrier were interviewed for this study. Using uncertainty management theory as a theoretical framework, this study demonstrates that men manage uncertainty by seeking information from female family members, websites, and healthcare providers, and are under-informed about their cancer risks. Further, in handling their information, men prefer information about cancer risk percentages and screening recommendations in the form of lists presented to them via websites, printed literature, proactive healthcare providers, and an identifiable male spokesperson. Finally, men used BRCA-related cancer risk information to make decisions about whether or not to engage in screening and prevention, manage their BRCA-related cancer risks, and overall family well-being-yet often at the expense of their own individual risks. Implications for genetic counseling and family conversations are discussed.
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