1
|
Limoges J, Chiu P, Dordunoo D, Puddester R, Pike A, Wonsiak T, Zakher B, Carlsson L, Mussell JK. Nursing strategies to address health disparities in genomics-informed care: a scoping review. JBI Evid Synth 2024; 22:2267-2312. [PMID: 39258479 PMCID: PMC11554251 DOI: 10.11124/jbies-24-00009] [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] [Indexed: 09/12/2024]
Abstract
OBJECTIVE The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda. INTRODUCTION The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required. INCLUSION CRITERIA Published (qualitative, quantitative, mixed methods studies; systematic and literature reviews; and text and opinion papers) and unpublished (gray) literature that focused on genomics-informed nursing strategies to address health disparities over the past 10 years were included. No limitations were placed on language. METHODS The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis, and the summarized results are presented using descriptive statistics and evidence tables. RESULTS In total, we screened 818 records and 31 were included in the review. The most common years of publication were 2019 (n=5, 16%), 2020 (n=5, 16%), and 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%), and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 39%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services among ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%), and individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%). CONCLUSIONS Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science that measures health outcomes is needed to identify best practices. SUPPLEMENTAL DIGITAL CONTENT A French-language version of the abstract of this review is available: http://links.lww.com/SRX/A65 .
Collapse
Affiliation(s)
- Jacqueline Limoges
- Athabasca University, Edmonton, AB, Canada
- Ontario Cancer Research Ethics Board, Toronto, ON, Canada
| | | | - Dzifa Dordunoo
- Faculty of Health Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Rebecca Puddester
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, NL, Canada
| | - April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John’s, NL, Canada
| | - Tessa Wonsiak
- Faculty of Health Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Bernadette Zakher
- University of Victoria Collaborative for Evidence Informed Healthcare: A JBI Centre of Excellence, Victoria, BC, Canada
| | | | - Jessica K. Mussell
- University of Victoria Collaborative for Evidence Informed Healthcare: A JBI Centre of Excellence, Victoria, BC, Canada
| |
Collapse
|
2
|
Nisselle A, Terrill B, Janinski M, Metcalfe S, Gaff C. Ensuring best practice in genomics education: A scoping review of genomics education needs assessments and evaluations. Am J Hum Genet 2024; 111:1508-1523. [PMID: 38959884 PMCID: PMC11339611 DOI: 10.1016/j.ajhg.2024.06.005] [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: 01/22/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024] Open
Abstract
A health workforce capable of implementing genomic medicine requires effective genomics education. Genomics education interventions developed for health professions over the last two decades, and their impact, are variably described in the literature. To inform an evaluation framework for genomics education, we undertook an exploratory scoping review of published needs assessments for, and/or evaluations of, genomics education interventions for health professionals from 2000 to 2023. We retrieved and screened 4,659 records across the two searches with 363 being selected for full-text review and consideration by an interdisciplinary working group. 104 articles were selected for inclusion in the review-60 needs assessments, 52 genomics education evaluations, and eight describing both. Included articles spanned all years and described education interventions in over 30 countries. Target audiences included medical specialists, nurses/midwives, and/or allied health professionals. Evaluation questions, outcomes, and measures were extracted, categorized, and tabulated to iteratively compare measures across stages of genomics education evaluation: planning (pre-implementation), development and delivery (implementation), and impact (immediate, intermediate, or long-term outcomes). They are presented here along with descriptions of study designs. We document the wide variability in evaluation approaches and terminology used to define measures and note that few articles considered downstream (long-term) outcomes of genomics education interventions. Alongside the evaluation framework for genomics education, results from this scoping review form part of a toolkit to help educators to undertake rigorous genomics evaluation that is fit for purpose and can contribute to the growing evidence base of the contribution of genomics education in implementation strategies for genomic medicine.
Collapse
Affiliation(s)
- Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Bronwyn Terrill
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Monika Janinski
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Mir ZM, Fei LYN, McKeown S, Dinchong R, Cofie N, Dalgarno N, Rusnak A, Cheifetz RE, Merchant SJ. Knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among surgeons: a scoping review. Can J Surg 2024; 67:E118-E127. [PMID: 38503461 PMCID: PMC10959449 DOI: 10.1503/cjs.001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The rapid evolution of genetic technologies and utilization of genetic information for clinical decision-making has necessitated increased surgeon participation in genetic counselling, testing, and appropriate referral of patients for genetic services, without formal training in genetics. We performed a scoping review to describe surgeons' knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy in the management of patients who had confirmed cancer or who were potentially genetically at risk. METHODS We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We performed a comprehensive literature search, and 2 reviewers independently screened studies for inclusion. These studies included surgeons involved in the care of patients with confirmed gastrointestinal, breast, and endocrine and neuroendocrine cancers, or patients who were potentially genetically at risk for these cancers. RESULTS We analyzed 17 studies, all of which used survey or interview-based formats. Many surgeons engaged in genetic counselling, testing, and referral, but reported low confidence and comfort in doing so. Knowledge assessments showed lower confidence in identifying genetic inheritance patterns and hereditary cancer syndromes, but awareness was higher among surgeons with greater clinical volume or subspecialty training in oncology. Surgeons felt responsible for facilitating these services and explicitly requested educational support in genetics. Barriers to genetic literacy were identified and catalogued at patient, surgeon, and system levels. CONCLUSION Surgeons frequently engage in genetics-related tasks despite a lack of formal genetics training, and often report low knowledge, comfort, and confidence in providing such services. We have identified several barriers to genetic literacy that can be used to develop interventions to enhance genetic literacy among surgeons.
Collapse
Affiliation(s)
- Zuhaib M Mir
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Linda Y N Fei
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Sandra McKeown
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rachelle Dinchong
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nicholas Cofie
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nancy Dalgarno
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Alison Rusnak
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rona E Cheifetz
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Shaila J Merchant
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| |
Collapse
|
4
|
Thomas J, Keels J, Calzone KA, Badzek L, Dewell S, Patch C, Tonkin ET, Dwyer AA. Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022). Genes (Basel) 2023; 14:2013. [PMID: 38002957 PMCID: PMC10671121 DOI: 10.3390/genes14112013] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.
Collapse
Affiliation(s)
- Joanne Thomas
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
| | - Jordan Keels
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
| | - Kathleen A. Calzone
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Genetics Branch, Bethesda, MD 20892, USA
| | - Laurie Badzek
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Ross and Carol Nese College of Nursing, Penn State University, University Park, PA 16802, USA
| | - Sarah Dewell
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- School of Nursing, Thompson Rivers University, Kamloops, BC V2C 0C8, Canada
| | - Christine Patch
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Engagement and Society, Wellcome Connecting Science, Hinxton CB10 1RQ, UK
| | - Emma T. Tonkin
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
| |
Collapse
|
5
|
Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
Collapse
Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| |
Collapse
|
6
|
Jimenez S, Matthews A, Darrah R, Schreiber A, Ricker C, Wolfe Schneider K. Perspectives on Spanish language concordant cancer genetic counseling sessions from the Spanish-speaking population. J Genet Couns 2023; 32:111-127. [PMID: 36117419 DOI: 10.1002/jgc4.1628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/07/2022]
Abstract
Genetic counselors (GCs) provide risk assessment, education, and counseling about the genetic contribution to disease. To do so, they must effectively communicate, build rapport, and help patients make the best decisions for themselves and their families. Language barriers add a complex layer to this patient-provider dynamic. While interpreters serve as a primary solution when a patient and GC speak different languages, issues have been documented with these sessions, such as misinterpreted genetic terminology (Gutierrez et al., 2017). Having a GC with concordant language skills may help address these barriers. The purpose of this study was to assess Spanish-speaking patients' perspectives on communication, decision-making, and the interpersonal relationship developed with a bilingual GC in language concordant cancer genetic counseling sessions. Spanish-speaking patients, ages 18 or older, seen by a Spanish-speaking GC at a California public, safety-net hospital were eligible to participate in this study. Nine participants were interviewed via telephone by the bilingual researcher using a semi-structured interview guide to assess three domains: communication, decision-making, and interpersonal relationship. Analyses of interview transcripts identified themes within these three areas of focus: (1) participants felt all explanations were clear and they were not afraid to ask questions in the session, (2) participants experienced preference-concordant decision making, and (3) participants felt empowered and supported by the GC. Participants suggested that GCs working with Spanish-speaking patients in the future should consider group counseling sessions, engaging in outreach efforts to educate the Spanish-speaking community about genetics, and increasing the number of GCs who speak Spanish. These results demonstrate the positive experiences of Spanish-speaking patients in language concordant cancer genetic counseling sessions and further support the need for recruitment of Spanish-speaking individuals into the profession. Future research should further assess the experience of Spanish-speaking patients in language concordant sessions and address the role of cultural concordance in sessions.
Collapse
Affiliation(s)
- Sharisse Jimenez
- Invitae Genetics, San Francisco, California, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anne Matthews
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rebecca Darrah
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Schreiber
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio, USA
| | - Charité Ricker
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kami Wolfe Schneider
- Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado, USA
| |
Collapse
|
7
|
Gunn CM, Li EX, Gignac GA, Pankowska M, Loo S, Zayhowski K, Wang C. Delivering Genetic Testing for Patients with Prostate Cancer: Moving Beyond Provider Knowledge as a Barrier to Care. Cancer Control 2023; 30:10732748221143884. [PMID: 36946278 PMCID: PMC10037728 DOI: 10.1177/10732748221143884] [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] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The 2018 National Comprehensive Cancer Network guidelines for prostate cancer genetic testing expanded access to genetic services. Few studies have examined how this change has affected provider practice outside of large cancer centers. METHODS We conducted a qualitative study of multi-disciplinary health care providers treating patients with prostate cancer at a safety-net hospital. Participants completed an interview that addressed knowledge, practices, and contextual factors related to providing genetic services to patients with prostate cancer. A thematic analysis using both inductive and deductive coding was undertaken. RESULTS Seventeen providers completed interviews. Challenges in identifying eligible patients for genetic testing stemmed from a lack of a) systems that facilitate routine patient identification, and b) readily available family history data for eligibility determination. Providers identified non-medical patient characteristics that influenced their referral process, including health literacy, language, cultural beliefs, patient distress, and cost. Providers who see patients at different times along the cancer care continuum viewed benefits of testing differently. CONCLUSION The use of digital technologies that systematically identify those eligible for genetic testing referrals may mitigate some but not all challenges identified in this study. Further research should determine how individual provider perceptions influence referral practices and patient access to genetics both within and across cancer specialties.
Collapse
Affiliation(s)
- Christine M. Gunn
- Geisel School of Medicine at
Dartmouth, The
Dartmouth Institute for Health Policy and Clinical Practice and
Dartmouth Cancer Center, Lebanon, NH,
USA
- Evans Department of Medicine,
Section of General Internal Medicine, Boston University Aram V. Chobanian &
Edward Avedisian School of Medicine,
Boston, MA, USA
- Department of Health Law, Policy,
and Management, Boston
University School of Public Health,
Boston, MA, USA
| | - Emma X. Li
- Evans Department of Medicine,
Boston University Aram V. Chobanian & Edward Avedisian School of Medicine,
Boston, MA, USA
| | - Gretchen A. Gignac
- Evans Department of Medicine,
Boston University Aram V. Chobanian & Edward Avedisian School of Medicine,
Boston, MA, USA
- Evans Department of Medicine,
Section of
Hematology and Oncology, Boston
University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston,
MA, USA
| | - Magdalena Pankowska
- Evans Department of Medicine,
Section of General Internal Medicine, Boston University Aram V. Chobanian &
Edward Avedisian School of Medicine,
Boston, MA, USA
| | - Stephanie Loo
- Department of Health Law, Policy,
and Management, Boston
University School of Public Health,
Boston, MA, USA
| | - Kimberly Zayhowski
- Evans Department of Medicine,
Section of
Hematology and Oncology, Boston
University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston,
MA, USA
| | - Catharine Wang
- Department of Community Health
Sciences, Boston
University School of Public Health,
Boston, MA, USA
| |
Collapse
|
8
|
Noordman J, Roodbeen R, Gach L, Schulze L, Rademakers J, van den Muijsenbergh M, Boland G, van Dulmen S. 'A basic understanding'; evaluation of a blended training programme for healthcare providers in hospital-based palliative care to improve communication with patients with limited health literacy. BMC MEDICAL EDUCATION 2022; 22:613. [PMID: 35953800 PMCID: PMC9371628 DOI: 10.1186/s12909-022-03685-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The non-curative setting makes communication and shared decision-making in palliative care extremely demanding. This is even more so for patients with limited health literacy. So far, research in palliative care focusing on shared decision-making with patients with limited health literacy is lacking. Recent research from our team indicates that the assessment of these patients' understanding of their situation and the implementation of shared decision-making in palliative care, needs improvement. METHODS To improve communication and decision-making, especially with patients with limited health literacy, we developed and evaluated a blended training programme for healthcare providers. The training programme comprised of an e-learning and a team training. The evaluation was performed by 1. conducting interviews (n = 15) focused on evaluating the whole programme and, 2. coding video-recorded outpatient consultations on the extent to which providers involved patients in decision-making before (n = 19) and after (n = 20) the intervention, using the 5-item OPTION coding instrument. RESULTS The interviews showed that healthcare providers valued the skills they had learned during the e-learning and team training. Providers specifically valued the teach-back technique, learned to use simpler wording and felt better able to recognize patients with limited health literacy. Many providers reported a change in communication behaviour as a consequence of the training programme. Suggestions for improvement for both e-learning and training were, amongst others, a follow-up team training course and a new scenarios for the e-learning about discussing palliative care. For both the pre- and the post-measurement, involving patients in decision-making lies between a minimal and a moderate effort; differences were not significant. CONCLUSIONS The e-learning and team training were valued positively by the healthcare providers. Adaptations to the e-learning have been made after evaluation. The e-learning has been implemented in several hospitals and medical education. To improve shared decision-making in practice a more sustained effort is needed.
Collapse
Affiliation(s)
- Janneke Noordman
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | - Ruud Roodbeen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Research Department, Breuer & Intraval, Research and Consultancy, Groningen, The Netherlands
| | - Leonie Gach
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Lotte Schulze
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gudule Boland
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| |
Collapse
|