Psychological and social predictors of decisions about genetic testing for breast cancer in high-risk women

The Need to Consider Context: A Systematic Review of Factors Involved in the Consent Process for Genetic Tests from the Perspective of Patients

Background: Informed consent for genetic tests is a well-established practice. It should be based on good quality information and in keeping with the patient's values. Existing informed consent assessment tools assess knowledge and values. Nevertheless, there is no consensus on what specific elements need to be discussed or considered in the consent process for genetic tests.Methods: We performed a systematic review to identify all factors involved in the decision-making and consent process about genetic testing, from the perspective of patients. Through public databases, we identified studies reporting factors that influence the decision to accept or decline genetic testing. Studies were included if they reported the perspective of patients or at-risk individuals. All articles were thematically coded.Results: 1989 articles were reviewed: 70 met inclusion criteria and 12 additional articles were identified through the references of included studies. Coding of the 82 articles led to the identification of 45 factors involved in decision-making and consent, which were initially divided into three domains: in favor of, against or with an undetermined influence on genetic testing. Each factor was also divided into three subdomains relating to the informed choice concept: knowledge, values or other. The factors in the "other" subdomain were all related to the context of testing (e.g. timing, cost, influence of family members, etc), and were present in all three domains.Conclusions: We describe the network of factors contributing to decision-making and consent process and identify the context of genetic testing as a third component to influence this process. Future studies should consider the evaluation of contextual factors as an important and relevant component of the consent and decision-making process about genetic tests. Based on these results, we plan to develop and test a more comprehensive tool to assess informed consent for genetic testing.

Factors shaping at-risk individuals' decisions to undergo genetic testing for cancer in Asia

This study aims to enrich our understanding of factors influencing medically indicated at-risk individuals' decisions to take genetic tests (or not) in the context of cancer treatment and prevention. While previous studies have explored this topic in communities in Europe and the United States, we know relatively little about the situation in Asia. In this study, we conducted in-depth interviews with 24 women who underwent genetic testing for hereditary breast and ovarian cancer syndromes in Singapore. Grounded theory with thematic analysis was applied. Six encouraging and three discouraging factors are identified in the analysis. The six encouraging factors are: desire to create awareness for self and family; perceived benefits for self and family; strong family history of cancer; presence of family support; medical professional recommendation and adequate amount of time to consider undertaking the test. The three discouraging factors are: high costs of tests; perceived lack of ability to cope with test results; and insufficient information about genetic testing. Taken together, the findings in this study add to the current literature by providing empirical evidence regarding the importance of holding family included pre-test counselling and providing adequate time for patients to decide to undergo genetic testing for hereditary cancer syndromes.

Organizational Twitter Use: Content Analysis of Tweets during Breast Cancer Awareness Month

On an average, at least one out of eight women are at risk of falling prey to breast cancer during their lifespan. Amongst varied initiatives to spread awareness about breast cancer, the most well-known campaign is Breast Cancer Awareness Month. This article explored, through content analysis, how four different health-related organizations-Susan G. Komen, U.S. News Health, Woman's Hospital, and Breast Cancer Social Media-used their Twitter accounts to talk about varied aspects of breast cancer during the month of October, which is observed as Breast Cancer Awareness Month. All the tweets by these organizations were analyzed for the presence or absence of the theoretical parameters of the Health Belief Model (HBM). A content analysis of 2916 tweets based on the HBM revealed that the content posted by these organizations reflected the use of varied theoretical constructs of the framework. Overall, the study demonstrated that while different organizations shared valuable breast cancer-related content on Twitter, each used the social media platform in a different fashion, evident through focus on different types of HBM constructs while publishing breast cancer-related tweets.

Effects of web-based intervention on risk reduction behaviors in melanoma survivors

PURPOSE

Melanoma is the most severe form of skin cancer, and survivors of melanoma carry increased risk of additional melanoma diagnosis. Multiple methods exist for primary and secondary prevention of melanoma in survivors. This study tested a web-based family communication intervention to improve these preventive behaviors in melanoma families.

METHODS

Families (a survivor, at least one first-degree relative and a parent) were randomized either to receive the intervention package or to serve as comparison families. We assessed melanoma prevention behaviors in each cohort member before and after the intervention. The intervention was a web-based multicomponent intervention focused on increasing family communication and exchange of risk information.

RESULTS

Results indicated that, compared to comparison survivors, intervention survivors improved their skin self-examination and their sun protection behaviors significantly from before to after intervention.

CONCLUSION

These data support the use of web-based interventions for behavioral changes in survivors and allow for consideration of dissemination of this successful intervention. These data have implications for interventions that can help cancer families deal with issues of risk and illness.

IMPLICATIONS FOR CANCER SURVIVORS

These data indicate that survivors can benefit from exposure to a website that helps direct their future health behaviors.

Attitudes toward direct-to-consumer advertisements and online genetic testing among high-risk women participating in a hereditary cancer clinic

Genetic testing for the breast cancer genes 1/2 (BRCA 1/2) has helped women determine their risk of developing breast and ovarian cancer. As interest in genetic testing has grown, companies have created strategies to disseminate information about testing, including direct-to-consumer advertising (DTCA) and online genetic testing. This study examined attitudes toward DTCA and online testing for BRCA among 84 women at a high-risk clinic as well as additional factors that may be associated with these attitudes, such as personal and familial cancer history, cancer worry and risk perception, and history with genetic testing/counseling. Results showed that the majority of the women held favorable attitudes toward DTCA for BRCA testing but did not support online testing. Factors such as familial ovarian cancer, cancer worry, and satisfaction with genetic counseling/testing were associated with positive attitudes toward DTCA, whereas personal breast cancer history was related to negative attitudes. The findings suggest that women may view DTCA as informational but rely on physicians for help in their decision to undergo testing, and also suggest that cancer history may affect women's acceptance of DTCA and genetic testing.

Factors influencing cancer risk perception in high risk populations: a systematic review

Background

Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history.

Methods

We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk.

Results

Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors.

Conclusions

Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still relatively undeveloped in several key topic areas including cancers other than breast and in specific populations. Future rigorous risk perception research using experimental designs and focused on cancers other than breast would advance the field.

Mutually dependent health beliefs associated with breast self-examination in British female university students

OBJECTIVE

Whereas research suggests young women's beliefs about breast cancer (susceptibility/severity) and its early detection (barriers/benefits) reliably distinguish breast self-examiners from nonexaminers, this study assessed whether these impressions are interreliant, especially in the context of familial risk.

PARTICIPANTS

The sample comprised over 200 female undergraduates from a university in England, United Kingdom.

METHODS

Participants completed a self-administered survey on their attitudes concerning breast cancer and early detection. Data were analyzed using logistic regression analysis.

RESULTS

Nonexaminers were distinguished by a combination of greater perceived hindrances to self-examinations and stronger appraisals of breast cancer severity, and also by a permutation of fewer perceived benefits in self-examinations and lower perceived susceptibility to breast cancer. The latter interaction persisted after accounting for family history.

CONCLUSIONS

Interwoven attitudes may depict sophisticated efforts on the part of nonexaminers to justify inaction. Clinical implications for college health providers are considered.

Public Awareness of Risk Factors for Cancer and Its Determinants in an Iranian Population

Cancer is increasingly being seen as a disease that is preventable and manageable. Knowledge often does constitute one element in the behavior change process. In addition, to promote the cancer prevention programs, data on level of knowledge among the target population are needed. The present research (as the first) aimed at providing information on level and correlates of awareness of cancer risk factors among the general public in Iran. The level of knowledge about 12 cancer risk factors (as a section of a multipart questionnaire) was assessed in a representative sample of 2500 adults (aged >18 years) in Tehran, Iran. The data were analyzed using latent class regression with the R statistical package. A small proportion of the respondents (12.2%) had high knowledge level and most of them had mixed (56.9%) and low level of awareness (30.9%). The most important determinants of knowledge level included level of education, gender, and family history. The results provided valuable clues and guidelines toward the formulation of relevant cancer prevention strategies, especially within the scope of health education. The applied statistical model presented a new descriptive and analytical perspective to evaluate the level of knowledge about the cancer risk factors and its determinants.

Cancer genetics service interest in women with a limited family history of breast cancer

Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.

Beliefs about cancer causation and prevention as a function of personal and family history of cancer: a national, population-based study

OBJECTIVE

Research suggests individuals possess multifaceted cognitive representations of various diseases. These illness representations consist of various beliefs, including causal attributions for the disease, and are believed to motivate, guide, and shape health-related behavior. As little research has examined factors associated with beliefs about cancer causation, this study examined the relationship between personal and family history of cancer and beliefs about the causes and prevention of malignant disease.

METHODS

Data were obtained from 6369 adult respondents to the 2003 Health Information National Trends Survey, a national population-based survey. Information about personal and family history of cancer and beliefs regarding cancer causation and prevention was obtained.

RESULTS

Results showed both a personal and family history of cancer were associated with differences in beliefs about the causes of cancer. In general, a personal history of cancer was not significantly linked to causal attributions for cancer relative to those without a personal history. In contrast, a family history of cancer tended to increase the likelihood a respondent viewed a particular cause as increasing cancer risk. Thus, personal and vicarious experience with cancer had dramatically diverging influences on attributions of cancer causation, which may be due to differing self-protection motives.

CONCLUSION

Results support the belief that illness representations, in this case the causal belief component, are influenced by both personal and vicarious experience with a disease and also suggest illness representations may influence receptivity to messages and interventions designed to increase appropriate cancer risk reduction behavior.

Assessing hypothetical scenario methodology in genetic susceptibility testing analog studies: a quantitative review

Hypothetical scenario methodology is commonly employed in the study of genetic susceptibility testing uptake estimation. The methodology, however, has not been rigorously assessed and sizeable gaps exist between estimated and actual uptake for tests that have recently become available. This quantitative review explores the effect of several theoretically based factors on genetic test uptake accuracy among a sample of 38 articles. These factors include verbal immediacy and temporal proximity of test scenarios, method of decision assessment, content of testing detail provided, processing demand required, and study features related to administration and sample. A number of assessed factors influenced uptake accuracy. Among these, temporal proximity of the genetic susceptibility test appeared to be the most consistent. There was also some evidence for effects of verbal immediacy and decision-assessment method on interest in testing. We recommend strategies for increasing accuracy using hypothetical scenario methodology to examine genetic susceptibility test uptake prediction.

Knowledge and attitudes towards genetic testing: a two year follow-up study in patients with asthma, diabetes mellitus and cardiovascular disease

Adequate knowledge and personal attitudes towards DNA-testing are major determinants of optimal utilization of genetic testing. This study aims to (1) assess the genetic knowledge and attitude towards genetic testing of patients with asthma, diabetes mellitus type II and cardiovascular diseases, (2) determine whether their knowledge or attitude changed since 2002, and (3) investigate the predictive role of knowledge on attitude. Data were collected within the Panel of Patients with Chronic Diseases in 2002 and 2004, resulting in 398 data-pairs. Results show that factual knowledge mainly relates to associations between genes and diseases, less is known on associations between genes, chromosomes, cells and body. The perceived knowledge on DNA-testing has not increased since 2002. The attitude towards genetic testing also appeared to be rather consistent. Less perceived medical genetic knowledge and more perceived social genetic knowledge were found predictive for a more reserved attitude towards genetic testing. In conclusion, advanced developments in the field of genetics are not accompanied by increased knowledge of patients with common multi-factorial diseases. The finding that more perceived social genetic knowledge results in more reluctance can be considered an indicator for the necessity of social debates on genetic testing.

Gesundheit durch Gentests?

Zusammenfassung. Prä- und postnatale genetische Diagnostik zur Ermittlung eines individuellen Erkrankungsrisikos gewinnt zunehmend an Bedeutung. Dementsprechend sind genetische Untersuchungen des menschlichen Erbgutes sowie damit verbundene Anwendungsbereiche Gegenstand intensiver gesellschaftlicher Diskussion. Zu den möglichen Vor- und Nachteilen genetischer Untersuchungen wurde eine deutschlandrepräsentative Stichprobe (N = 2.076 Personen) befragt. Die Ergebnisse zeigen, dass genetische Untersuchungen insgesamt auf eine große Akzeptanz in der Bevölkerung stoßen, ca. zwei Drittel stehen ihnen befürwortend gegenüber. Jedoch werden auch mögliche Nachteile solcher diagnostischer Maßnahmen, wie z.B. Schwangerschaftsabbrüche oder Diskriminierung, benannt. Faktorenanalytisch ließen sich aus den 13 Items des eingesetzten Fragebogens drei Skalen (Positive Aspekte, Negative Aspekte, Befürchtungen) bilden. Eine Varianzanalyse erbrachte Unterschiede in den Skalen zwischen verschiedenen soziodemographischen Gruppen: Während Geschlecht und Lebensalter keinen bzw. wenig Einfluss haben (Ältere sehen mehr negative Aspekte als Jüngere), finden sich deutliche Unterschiede zwischen konfessionsgebundenen und konfessionslosen Personen. Die Befragten, die einer Religionsgemeinschaft angehören, sehen genetische Untersuchungen wesentlich kritischer. Hinsichtlich des Bildungsstandes ist festzustellen: Personen mit höherer Bildung sehen mehr positive und weniger negative Aspekte hinsichtlich genetischer Untersuchungen. Die Ergebnisse werden mit internationalen Studien verglichen. Abschließend werden Überlegungen zur Relevanz genetischer Untersuchungen und der sich abzeichnenden weiteren Entwicklungen für die Gesundheitspsychologie angestellt.