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Fehlberg Z, Fisher L, Liu C, Kugenthiran N, Milne RL, Young MA, Willis A, Southey MC, Goranitis I, Best S. Using a behaviour-change approach to support uptake of population genomic screening and management options for breast or prostate cancer. Eur J Hum Genet 2025; 33:108-120. [PMID: 39532988 PMCID: PMC11711511 DOI: 10.1038/s41431-024-01729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/16/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024] Open
Abstract
As the possibility of implementing population genomic screening programs for the risk of developing hereditary cancers in health systems increases, understanding how to support individuals who wish to have genomic screening is essential. This qualitative study aimed to link public perceived barriers to a) taking up the offer of population genomic screening for breast or prostate cancer risk and b) taking up risk-management options following their result, with possible theory-informed behaviour-change approaches that may support implementation. Ten focus groups were conducted with a total of 25 members of the Australian public to identify and then categorise barriers within the behaviour-change Capability, Opportunity, Motivation - Behaviour (COM-B) model. Ten COM-B categorised barriers were identified as perceived influences on an individual's intentions to take-up the offer, including Capability (e.g., low public awareness), Opportunity (e.g., inconvenient sample collection procedure) and Motivation (e.g., genomic screening not perceived as relevant to an individual). Ten barriers for taking up risk-management options included Motivation (e.g., concerns about adverse health impact) and Opportunity (e.g., social opportunity and cost incurred to the individual). Our findings demonstrate that a nuanced approach is required to support people to take-up the offer of population genomic screening and, where appropriate, to adopt risk-management options. Even amongst participants who were enthusiastic about a population genomic screening program, needs were varied, demanding a range of implementation strategies. Promulgating equitable uptake of genomic screening and management options for breast and prostate cancer risk will require a needs-based approach.
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Affiliation(s)
- Zoe Fehlberg
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Louise Fisher
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cun Liu
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nathasha Kugenthiran
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Mary-Anne Young
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Amanda Willis
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Ilias Goranitis
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- The University of Melbourne, School of Health Sciences, Melbourne, VIC, Australia.
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Kautz-Freimuth S, Lautz Z, Shukri A, Redaèlli M, Rhiem K, Schmutzler R, Stock S. Decisional conflict and knowledge in women with BRCA1/2 pathogenic variants: An exploratory age group analysis of a randomised controlled decision aid trial. PLoS One 2024; 19:e0311432. [PMID: 39446752 PMCID: PMC11500967 DOI: 10.1371/journal.pone.0311432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 09/18/2024] [Indexed: 10/26/2024] Open
Abstract
Female BRCA1/2 pathogenic variant (PV) carriers face substantial risks for breast and ovarian cancer. Evidence-based decision aids (DAs) can facilitate these women in their decision-making process on an individually suitable preventive strategy. However, there is a gap in previous literature exploring whether DA effectiveness varies according to women's age. This is an exploratory subanalysis with a descriptive approach from a randomised controlled study assessing the effectiveness of a German decision aid (DA) for women with BRCA1/2 PVs compared to no DA use. From the original sample, women aged 18-40 years and >40 years and the intervention and control groups (IG, CG) within each of the age groups were compared regarding decisional conflict (using the Decisional Conflict Scale DCS) and knowledge at baseline and after DA use three and six months post study inclusion. The subanalysis involved 236 women aged 18-40 and 181 women aged >40 years. At baseline, both age groups differed significantly in all socio-demographic variables, except BRCA1/2 PV distributions. The younger age group displayed higher scores in the DCS subscale informed (p = .002) and higher knowledge (p = .010). Among the 18-40-year-olds, DA use (versus no DA) led to improvements in the DCS subscale informed at three (p = .025) and six months (p = .000). In the >40-year-olds, DA use (versus no DA) led to improvements in the DCS subscales informed (p = .028), values clarity (p = .028) and support (p = .030) and increased knowledge at three months (p = .048). These results indicate that both age groups benefited from DA use, but the older ones did so to a greater extent. This suggests that it might be useful to tailor DAs more closely to age- or life stage-related needs to enable more personalised care and support for women with BRCA1/2 PVs.
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Affiliation(s)
- Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Zoë Lautz
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rita Schmutzler
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Uslu Y, Er S, Subaşı Sezgin D, Yeşilyurt A, Uras C. What Do Breast Cancer Previvors Tell Us About Their Stories? To Know or Not to Know? Semin Oncol Nurs 2024; 40:151714. [PMID: 39164159 DOI: 10.1016/j.soncn.2024.151714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/22/2024] [Accepted: 07/19/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVES This study aimed to explore the (1) experiences of breast cancer previvor women during genetic testing; (2) perceptions of the impact of genetic testing on their personal, social, family, and professional lives; and (3) views on breast cancer prevention and follow-up processes. This study focused on the risk of breast cancer in persons with BRCA mutations. METHODS Data were collected through individual in-depth semistructured interviews. The data were analyzed using the MAXQDA program based on the method suggested by Graneheim and Lundman. RESULTS This study was conducted in Istanbul, Turkey, and included 17 participants. Five themes emerged from the data analysis-Acquaintance with BRCA, Living with BRCA, Managing the Legacy, Maternalism, and We Are Here, including a total of 12 categories. CONCLUSION The previvors had negative experiences during genetic testing, mainly owing to a lack of information, stigma, and women's roles in society. A structured and individualized process for genetic counseling was identified as the main requirement. IMPLICATIONS FOR NURSING PRACTICE National and international policies on breast cancer previvors should be developed to prevent breast cancer and reduce mortality. Adopting a multidisciplinary approach during genetic counseling will favorably contribute to previvors' medical and psychosocial well-being. Follow-up programs before and after genetic testing should be created. Society's cultural and genetic literacy levels should be evaluated, and activities should be planned to raise social awareness.
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Affiliation(s)
- Yasemin Uslu
- Department of Surgical Nursing, Istanbul University, Faculty of Nursing, Fatih, İstanbul.
| | - Seda Er
- Department of Mental Health and Psychiatric Nursing, Istanbul University-Cerrahpaşa, Florence Nightingale Faculty of Nursing, İstanbul
| | | | | | - Cihan Uras
- Acibadem University, Institute of Senology, İstanbul
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Lautz Z, Kautz-Freimuth S, Shukri A, Redaèlli M, Rhiem K, Schmutzler R, Stock S. Predictors of knowledge and knowledge gain after decision aid use among women with BRCA1/2 pathogenic variants. PATIENT EDUCATION AND COUNSELING 2024; 124:108248. [PMID: 38513456 DOI: 10.1016/j.pec.2024.108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To identify factors contributing to baseline knowledge in women with BRCA1/2 pathogenic variants (PVs) and knowledge gain after decision aid (DA) use. METHODS Women with PVs in BRCA1 or BRCA2 genes were randomly assigned to an intervention group (IG) receiving DAs or a control group (CG). Of the total sample, 417 completed the baseline survey and were included in this analysis. Two multiple regression analyses were conducted: baseline data on socio-demographic, medical, decision-related and psychological variables were used to identify predictors for (1) baseline knowledge within the total group and (2) knowledge gain within the IG after DA use three months post study inclusion. RESULTS At baseline, higher education status, no breast cancer history, and lower decisional conflict related to higher knowledge within the total group. After DA use within the IG, higher baseline scores for decisional conflict predicted higher knowledge gain, and higher baseline scores for depression and intrusion predicted lower knowledge gain. CONCLUSIONS This study identified predictors of baseline knowledge and knowledge gain after DA use in women with BRCA1/2 PVs. PRACTICE IMPLICATIONS Awareness of facilitating and hindering factors on these women's knowledge can improve understanding of their health literacy and enable further targeted support interventions.
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Affiliation(s)
- Zoë Lautz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany.
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Kerstin Rhiem
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Rita Schmutzler
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
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Hesse-Biber S, Seven M, Shea H, Heaney M, Dwyer AA. Racial and Ethnic Disparities in Genomic Healthcare Utilization, Patient Activation, and Intrafamilial Communication of Risk among Females Tested for BRCA Variants: A Mixed Methods Study. Genes (Basel) 2023; 14:1450. [PMID: 37510354 PMCID: PMC10378850 DOI: 10.3390/genes14071450] [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: 05/21/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to gain a deeper understanding of genomic healthcare utilization, patient activation, and intrafamilial risk communication among racially and ethnically diverse individuals tested for BRCA variants. We employed an explanatory, sequential, mixed-methods study guided by the Theory of Planned Behavior. Participants completed an online survey, including sociodemographic, medical history, and several validated instruments. A subset of participants participated in in-depth, semi-structured interviews. A total of 242 women were included in the quantitative analyses. The majority of survey participants identified as non-Hispanic white (NHW) (n = 197, 81.4%) while 45/242 (18.5%) identified as black, Indigenous, and people of color (BIPOC). The NHW participants were more likely to communicate genetic test results with healthcare providers, family, and friends than BIPOC participants (p < 0.05). BIPOC participants had lower satisfaction with testing decisions and significantly higher ratings of personal discrimination, fatalism, resilience, uncertainty, and lower patient activation scores (p < 0.05). Participants with higher education, greater satisfaction with testing decisions, and lower resilience are more likely to communicate BRCA test results with family members through the mediating effect of patient activation. Bridging disparities to ensure that genomic healthcare benefits all people may demand theory-driven, multi-level interventions targeting the individual, interpersonal, and healthcare system levels.
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Affiliation(s)
- Sharlene Hesse-Biber
- Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA; (S.H.-B.); (H.S.); (M.H.)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Hannah Shea
- Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA; (S.H.-B.); (H.S.); (M.H.)
| | - Madeline Heaney
- Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA; (S.H.-B.); (H.S.); (M.H.)
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA;
- Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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