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Sium AF, Shimels T, Abdosh AA, Diress T, Tsegaye T, Yifrashewa T, Terefework Z, Gudu W. Indications, types, and diagnostic implications of prenatal genetic testing in Sub-Saharan Africa: A descriptive study. PLoS One 2023; 18:e0294409. [PMID: 37972098 PMCID: PMC10653539 DOI: 10.1371/journal.pone.0294409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To describe indications, test types, and results of prenatal diagnostic genetic amniocentesis among Ethiopian pregnant women. METHODS This study was a descriptive study on prenatal diagnostic genetic testing among Ethiopian pregnant women with certain indications and it was conducted at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia) from January 2017 to April 2023. Data on sociodemographic characteristics, genetic testing indications, types, and results were collected electronically. Data were analysed using SPSS version 23. RESULTS A total of 159 cases were analysed. The commonest indication for genetic testing among the study subjects was major fetal structural anomalies identified on specialized prenatal anatomic scanning of the index pregnancy detected in 71(44.7%) cases. Down syndrome and Edward syndrome were the commonest genetic aberrations detected accounting for 6.3% (10/159) and 4.4% (7/159), respectively. Among the rare genetic aberration detected were Di-George syndrome (0.6%) and Duchenne muscular dystrophy (0.6%). CONCLUSION Findings of our study underscore the importance of diagnostic prenatal testing in a Sub-Saharan Africa setting, as common (trisomy 21&18) and rare genetic defects were identified using this important prenatal diagnostic testing. Considering the implications of detecting chromosomal abnormalities for future counselling and care, carrier state in parents for some chromosomal anomalies, and planning post-natal management of some abnormalities that are associated with aneuploidies (notably cardiac anomalies), initiation of diagnostic prenatal genetic testing service at tertiary public health facilities should be acted up on.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of obstetrics and Gynecology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tariku Shimels
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Tesfaye Diress
- Department of obstetrics and Gynecology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Wondimu Gudu
- Department of obstetrics and Gynecology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Hsu DS, Jiang SF, Habel LA, Hoodfar E, Karlea A, Manace-Brenman L, Dzubnar JM, Shim VC. Germline Genetic Testing Among Women ≤ 45 Years of Age with Ductal Carcinoma In Situ Versus Invasive Breast Cancer in a Large Integrated Health Care System. Ann Surg Oncol 2023; 30:6454-6461. [PMID: 37386303 DOI: 10.1245/s10434-023-13745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND We compared the results of hereditary cancer multigene panel testing among patients ≤ 45 years of age diagnosed with ductal carcinoma in situ (DCIS) versus invasive breast cancer (IBC) in a large integrated health care system. METHODS A retrospective cohort study of hereditary cancer gene testing among women ≤ 45 years of age diagnosed with DCIS or IBC at Kaiser Permanente Northern California between September 2019 and August 2020 was performed. During the study period, institutional guidelines recommended the above population be referred to genetic counselors for pretesting counseling and testing. RESULTS A total of 61 DCIS and 485 IBC patients were identified. Genetic counselors met with 95% of both groups, and 86.4% of DCIS patients and 93.9% of IBC patients (p = 0.0339) underwent gene testing. Testing differed by race/ethnicity (p = 0.0372). Among those tested, 11.76% (n = 6) of DCIS patients and 16.71% (n = 72) of IBC patients had a pathogenic variant (PV) or likely pathogenic variant (LPV) based on the 36-gene panel (p = 0.3650). Similar trends were seen in 13 breast cancer (BC)-related genes (p = 0.0553). Family history of cancer was significantly associated with both BC-related and non-BC-related PVs in IBC, but not DCIS. CONCLUSION In our study, 95% of patients were seen by a genetic counselor when age was used as an eligibility criterion for referral. While larger studies are needed to further compare the prevalence of PVs/LPVs among DCIS and IBC patients, our data suggest that even in younger patients, the prevalence of PVs/LPVs in BC-related genes is lower in DCIS patients.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Genetic Predisposition to Disease
- Retrospective Studies
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Genetic Testing
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Affiliation(s)
- Diana S Hsu
- University of California San Francisco, East Bay, Oakland, CA, USA
| | | | - Laurel A Habel
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Audrey Karlea
- Department of Genetics, Kaiser Permanente, Oakland, CA, USA
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Lumpkins CY, Nelson R, Twizele Z, Ramírez M, Kimminau KS, Philp A, Mustafa RA, Godwin AK. Communicating risk and the landscape of cancer prevention - an exploratory study that examines perceptions of cancer-related genetic counseling and testing among African Americans and Latinos in the Midwest. J Community Genet 2023; 14:121-133. [PMID: 36930422 PMCID: PMC10021032 DOI: 10.1007/s12687-022-00629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/21/2022] [Indexed: 03/18/2023] Open
Abstract
African American (AA) and Latino populations are impacted disproportionately by cancer incidence and mortality compared to the general US population. Contributing to these rates are multiple inheritable cancers that impact both men and women. Some of these diseases may be detected through genetic counseling and germline DNA testing; however, AA and Latinos are unaware and have limited knowledge and thus significantly underutilize these services and technologies. Research to detect influencing factors to testing uptake has also been slow due to multiple factors. The research team followed a community-based participatory research (CBPR) approach and worked with a Community Advisory Board composed of cancer survivors and co-survivors to design the exploratory study. Six focus groups were held with a pilot sample of African Americans and Latinos who self-reported to be at-risk for cancer (N = 53). The study was held over a 2-month period where attitudes, perceptions, and beliefs about cancer risk and preference regarding cancer-related genetic counseling and testing risk communication were explored. Themes that emerged included (1) the lack of knowledge about cancer-related genetic counseling and testing; (2) cancer is feared often; (3) cancer-related genetic testing was perceived as something that could help but was also perceived as unnecessary testing that exposed individuals to medical harm; and (4) benefits to test were perceived as favorable for medical personnel but not for the patient. Implications of the study provide a unique lens to explore how lived experiences among AA and Latinos may inform strategic risk communication about cancer-related genetic counseling and testing and help advance cancer health equity. Participants viewed cancer genetic testing as important cancer risk prevention strategies. Identification of perceptions of cancer risk and cancer-related genetic counseling and testing in collaboration with members of the community is needed to bolster communication efforts among these populations.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Rafaela Nelson
- Pediatrics Department, University of Kansas Medical Center, Kansas City, KS, USA
| | - Zawadi Twizele
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Mariana Ramírez
- Department of Population Health, JUNTOS Center for Advancing Latino Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kim S Kimminau
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | | | - Reem A Mustafa
- Department of Internal Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Andrew K Godwin
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, KS, USA
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Dron HA, Bucio D, Young JL, Tabor HK, Cho MK. Latinx attitudes, barriers, and experiences with genetic counseling and testing: A systematic review. J Genet Couns 2023; 32:166-181. [PMID: 36301246 PMCID: PMC10091969 DOI: 10.1002/jgc4.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/05/2022]
Abstract
As genetics is increasingly used across clinical settings, there is a need to understand the impact and experiences of diverse patients. This review systematically examined research literature on Latinx experiences with genetic counseling and genetic testing (GC/GT) in the United States, synthesizing key themes and knowledge gaps pertaining to both patient experience and hypothetical scenarios. Findings were based on a systematic search, inclusion, and thematic analysis of 81 empirical peer-reviewed articles published from January 1990 to July 2019 pertaining to Latinx populations and GC/GT. Studies most commonly addressed Latinas' perspectives on GC/GT in prenatal settings or for hereditary breast and ovarian cancer (HBOC). Costs, referrals, and communication were significant barriers to accessing genetic services for many Latinx patients, particularly those with low English proficiency (LEP). Studies highlighted difficulties accessing and communicating in healthcare settings, and how medical context and prior experience with healthcare workers and institutions influenced GC/GT decision-making. Providers' implicit biases about Latinx patients negatively impacted their care and impeded communication. Despite low awareness of cancer GT, Latinx patients often reported interest in learning more about GC/GT or unmet needs for GT discussion and provider involvement. This systematic review identified areas where providers can take action to improve Latinx experiences with GC/GT. Clinicians should elicit and respond to patient preferences about shared decision-making. For patients with low numeracy or LEP, providers should consider tailored educational and communication techniques. Most studies focused on HBOC and prenatal testing, and Latinx patients are heterogeneous, leaving many research questions about Latinx experience with GT/GC in other clinical areas.
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Affiliation(s)
- Heather A Dron
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,University of Michigan, Ann Arbor, Michigan, USA
| | - Daiana Bucio
- Providence St. Joseph Health, Burbank, California, USA
| | - Jennifer L Young
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Departments of Medicine, and by courtesy, Epidemiology, Stanford University, Stanford, California, USA
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Department of Pediatrics, Stanford University, Stanford, California, USA
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Hicks NM, Heid AR, Abbott KM, Leser K, Van Haitsma K. Preference Importance Ratings among African American and White Nursing Home Residents. Clin Gerontol 2023; 46:111-121. [PMID: 34962458 PMCID: PMC9237178 DOI: 10.1080/07317115.2021.2007436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The Preferences for Everyday Living Inventory (PELI-NH) assesses psychosocial preferences of nursing home (NH) residents. This study explored the association of race with importance ratings of self-dominion preferences (i.e., preferences for control). METHODS PELI-NH interviews were conducted with 250 NH residents. Tests of mean differences compared African American (n = 57) and White (n = 193) residents on demographic (age, gender, education, length of stay) and clinical attributes (self-rated health, depressive symptoms, anxiety, functional limitations, hearing, vision, cognition). Stepwise multiple regression accounted first for associations of demographic and clinical attributes then for the unique association of race with total importance of self-dominion preferences to determine whether African American and White residents differ. For between group demographic/clinical differences, interaction effects were tested. RESULTS African Americans were younger and more functionally impaired. After accounting for the effects of gender (female), age (younger), anxiety (greater), and functional impairment (less) with higher reports of importance of self-dominion preferences, race was significant. There were no significant moderating effects. CONCLUSIONS African American residents reported greater importance of self-dominion preferences than Whites. CLINICAL IMPLICATIONS Cultural sensitivity is critical; it may be more important to provide opportunities for autonomous decision-making for African American than for White residents.
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Affiliation(s)
- Nytasia M. Hicks
- Miami University, Department of Sociology and Gerontology, Oxford, OH, USA
| | | | | | - Kendall Leser
- College of Education, Health & Society, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- The Polisher Research Institute at The Madlyn and Leonard Abramson Center for Jewish Life, Horsham, PA, USA and The Pennsylvania State University, University Park, PA, USA
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Pollak RM, Pincus JE, Burrell TL, Cubells JF, Klaiman C, Murphy MM, Saulnier CA, Walker EF, White SP, Mulle JG. Autism spectrum disorder symptom expression in individuals with 3q29 deletion syndrome. Mol Autism 2022; 13:50. [PMID: 36566217 PMCID: PMC9789637 DOI: 10.1186/s13229-022-00533-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The 1.6 Mb 3q29 deletion is associated with neurodevelopmental and neuropsychiatric phenotypes, including a 19-fold increased risk for autism spectrum disorder (ASD). Previous work by our team identified elevated social disability in this population via parent-report questionnaires. However, clinical features of ASD in this population have not been explored in detail. METHODS Thirty-one individuals with 3q29 deletion syndrome (3q29del, 61.3% male) were evaluated using two gold-standard clinical ASD evaluations: the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the Autism Diagnostic Interview, Revised (ADI-R). Four matched comparators for each subject were ascertained from the National Database for Autism Research. Item-level scores on the ADOS-2 and ADI-R were compared between subjects with 3q29del and matched comparators. RESULTS Subjects with 3q29del and no ASD (3q29del-ASD) had greater evidence of social disability compared to typically developing (TD) comparison subjects across the ADOS-2. Subjects with 3q29del and ASD (3q29del + ASD) were largely indistinguishable from non-syndromic ASD (nsASD) subjects on the ADOS-2. 3q29del + ASD performed significantly better on social communication on the ADI-R than nsASD (3q29 + ASD mean = 11.36; nsASD mean = 15.70; p = 0.01), and this was driven by reduced deficits in nonverbal communication (3q29 + ASD mean = 1.73; nsASD mean = 3.63; p = 0.03). 3q29del + ASD reported significantly later age at the first two-word phrase compared to nsASD (3q29del + ASD mean = 43.89 months; nsASD mean = 37.86 months; p = 0.01). However, speech delay was not related to improved nonverbal communication in 3q29del + ASD. LIMITATIONS There were not enough TD comparators with ADI-R data in NDAR to include in the present analysis. Additionally, our relatively small sample size made it difficult to assess race and ethnicity effects. CONCLUSIONS 3q29del is associated with significant social disability, irrespective of ASD diagnosis. 3q29del + ASD have similar levels of social disability to nsASD, while 3q29del-ASD have significantly increased social disability compared to TD individuals. However, social communication is reasonably well preserved in 3q29del + ASD relative to nsASD. It is critical that verbal ability and social disability be examined separately in this population to ensure equal access to ASD and social skills evaluations and services.
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Affiliation(s)
- Rebecca M. Pollak
- grid.430387.b0000 0004 1936 8796Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ USA
| | - Jordan E. Pincus
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Clinical Psychology, College of Arts and Sciences, Georgia State University, Atlanta, GA USA
| | - T. Lindsey Burrell
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA
| | - Joseph F. Cubells
- grid.189967.80000 0001 0941 6502Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Science, School of Medicine, Emory University, Atlanta, GA USA
| | - Cheryl Klaiman
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA
| | - Melissa M. Murphy
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA
| | - Celine A. Saulnier
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,Neurodevelopmental Assessment and Consulting Services, Decatur, GA USA
| | - Elaine F. Walker
- grid.189967.80000 0001 0941 6502Department of Psychology, Emory University, Atlanta, GA USA
| | - Stormi Pulver White
- grid.189967.80000 0001 0941 6502Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA USA
| | - Jennifer G. Mulle
- grid.430387.b0000 0004 1936 8796Center for Advanced Biotechnology and Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ USA ,grid.430387.b0000 0004 1936 8796Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, 679 Hoes Lane West, NJ 08854 Piscataway, USA
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Atkins R, Kelly TA, Johnson S, Deatrick JA, Wunnenberg M, Joseph PV, Pudasainee-Kapri S, Gage G, Pontes NMH, Cresse N, Williams W. Beliefs and willingness towards participating in genetic testing for depression in low-income and racial/ethnic minority mothers at-risk. Arch Psychiatr Nurs 2022; 41:153-165. [PMID: 36428043 PMCID: PMC11036348 DOI: 10.1016/j.apnu.2022.07.002] [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: 08/30/2020] [Revised: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression. DESIGN A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness. FINDINGS Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %). CONTROL Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %). CONCLUSIONS Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.
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Affiliation(s)
- Rahshida Atkins
- The College of New Jersey, School of Nursing and Health Sciences, 2000 Pennington Road, Room 113, Ewing, NJ 08102, USA.
| | - Terri-Ann Kelly
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Shanda Johnson
- New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ 07305, USA.
| | - Janet A Deatrick
- The University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA, USA.
| | - Mary Wunnenberg
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Paule V Joseph
- Section of Sensory Science and Metabolism (SenSMet), National Institute on Alcohol Abuse and Alcoholism & National Institute of Nursing Research, National Institutes of Health, Bethesda, MD.
| | - Sangita Pudasainee-Kapri
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Gale Gage
- Essex County College, Division of Nursing & Health Sciences, 303 University Avenue, Newark, NJ 07102, USA
| | - Nancy M H Pontes
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Nancy Cresse
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Wanda Williams
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
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Zuno-Reyes A, Matute E, Ernstrom K, Withers M, Rodriguez-Agudelo Y, Raman R, Ringman JM. Attitudes about involvement in hypothetical clinical trial protocols in Mexican and Mexican-American at risk for autosomal dominant Alzheimer's disease. Alzheimers Res Ther 2022; 14:173. [PMID: 36380395 PMCID: PMC9664662 DOI: 10.1186/s13195-022-01114-4] [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: 04/29/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The enrollment into clinical trials of persons at risk for autosomal dominant Alzheimer's disease (ADAD) in whom the onset of disease can be accurately predicted facilitates the interpretation of outcomes (e.g., biomarkers, treatment efficacy). Attitudes toward involvement in such studies are biased by intrinsic cultural and social characteristics. Our objective was to study how demographic factors such as country of residence, age, sex, schooling, parenthood, and urbanization affect attitudes towards participation in hypothetical clinical trials in Mexican families at risk for ADAD living either in Mexico or in the United States. METHODS Participants were 74 members of different families known to harbor an ADAD mutation living in Mexico (n = 50) or in the United States (n = 24). Participants were asked, in a written questionnaire, their interest in participating in four hypothetical clinical trial scenarios of increasing perceived invasiveness. The questionnaire then asked about their willingness should there be a 50% chance of being assigned to a placebo group. The influences of demographic variables on decisions were performed using Wilcoxon rank-sum for continuous variables and Fisher's exact test for categorical variables. RESULTS Participants who live in Mexico, who have or plan to have children, who do not attend or do not plan to attend school, and who live in rural areas gave more positive responses regarding their willingness to participate compared to those living in the U.S. The 50% chance of being in a placebo group increased the willingness to participate for family members living in Mexico. The main reason for participation was to help future generations, while the main reasons for refusal were not wanting to undergo genetic testing and consideration of adverse effects. CONCLUSIONS We found a higher level of willingness to participate in clinical trials among persons living in rural Mexico and our data suggest that altruism towards future generations is a major motivation, though this was balanced against concerns regarding side effects. Our results emphasize the importance of sharing information and assessing its understanding in potential participants with diverse backgrounds in the nature of ADAD and regarding the design of clinical trials prior to their enrollment in such studies.
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Affiliation(s)
- Angélica Zuno-Reyes
- Instituto de Neurociencias, CUCBA, Universidad de Guadalajara, Francisco de Quevedo 180, 44130, Guadalajara, Jalisco, Mexico.
| | - Esmeralda Matute
- Instituto de Neurociencias, CUCBA, Universidad de Guadalajara, Francisco de Quevedo 180, 44130, Guadalajara, Jalisco, Mexico
- Departamento de Estudios en Educación, CUCSH, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Karin Ernstrom
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mellissa Withers
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yaneth Rodriguez-Agudelo
- Department of Neuropsychology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rema Raman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John M Ringman
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA, USA
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Grafft N, Dwyer AA, Pineros-Leano M. Latinx individuals' knowledge of, preferences for, and experiences with prenatal genetic testing: a scoping review. Reprod Health 2022; 19:134. [PMID: 35668466 PMCID: PMC9169270 DOI: 10.1186/s12978-022-01438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The American College of Obstetricians and Gynecologists recommends prenatal genetic testing (PGT) be offered to all pregnant persons regardless of known risk factors. However, significant racial/ethnic differences exist regarding acceptance of PGT contributing to disparities. Latinas (Latinx), one of the fastest growing ethnic groups in the United States, have low PGT acceptance rates. This systematic scoping review aimed to provide a landscape of existing literature on Latinx individuals’ knowledge of, preferences for, and experiences with prenatal and preconception genetic testing. Synthesizing the current state of the science may inform development of culturally tailored interventions to support high-quality PGT decisions (e.g., informed, aligned with a pregnant persons’ values). Methods We conducted a structured, systematic literature search of published articles and gray literature in electronic databases (PubMed, PsycINFO, CINAHL, Medline, Embase, Eric, Social Services Abstracts, and PsycArticles). Articles in English published prior to March 2021 were retrieved relating to genetics, pregnancy, and Latina women. Articles underwent title, abstract and full-text review by independent investigators to assess inclusion and exclusion criteria. Risk of bias was evaluated by two investigators. Iterative thematic analysis was employed to group study findings into themes to identify possible targets for interventions. Results The search generated 5511 unique articles. After title screening, 335 underwent abstract review and subsequently 61 full-text review. Twenty-eight studies met inclusion criteria and 7 additional studies were included after reviewing reference lists. Three overarching themes emerged: genetic knowledge/literacy (26/35, 74%), provider (mis)communication/patient satisfaction (21/35, 60%), and cross-cultural beliefs (12/35, 34%). Studies indicate discordant patient-provider language (n = 5), miscommunication (n = 4), and lack of concordant decision-making (n = 4) pose barriers to high-quality PGT decisions. Immigration status (n = 1) and religious beliefs (n = 5) are additional factors influencing PGT decisions. Conclusions Identified studies suggest that cultural and linguistic factors affect Latinx PGT decision-making. Latinx individual’s comprehension and recall of PGT information is enhanced by culturally and linguistically concordant providers—suggesting that culturally-informed interventions may enhance PGT acceptability and support high-quality decisions. Future directions to surmount PGT disparities may include community health workers and cultural brokers to empower Latinx people to make informed decisions aligned with their values and preferences. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01438-2. Significant racial, ethnic, and language disparities exist in prenatal genetic testing (PGT). Latina (Latinx) people, one of the fastest growing ethnic groups in the United States, have low acceptance rates of PGT. This scoping review provides a systematic search of the literature to better understand Latinx individuals’ knowledge of, preferences for, and experiences with PGT. Eight electronic data bases were systematically searched and identified articles underwent title, abstract, full text, and reference review. Iterative thematic analysis was conducted to group article findings into themes. Thirty-five studies met inclusion criteria and three overarching themes were identified: genetic knowledge/literacy, provider (mis)communication/patient satisfaction, and cross-cultural beliefs. Findings indicate that discordant patient-provider decision making and language and patient provider miscommunication pose barriers to high-quality PGT decisions. Latinx individuals’ understanding and recall of PGT information is improved when delivered in a culturally and linguistically concordant manner. This suggests culturally-informed interventions, including the use of community health workers or cultural brokers, may enhance PGT acceptability and support high quality pregnancy decisions.
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Affiliation(s)
- Natalie Grafft
- School of Social Work, Boston College, Chestnut Hill, MA, 20467, USA.
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, 02467, USA.,Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, 02115, USA
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10
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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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11
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Kaphingst KA, Bather JR, Daly BM, Chavez-Yenter D, Vega A, Kohlmann WK. Interest in Cancer Predisposition Testing and Carrier Screening Offered as Part of Routine Healthcare Among an Ethnically Diverse Sample of Young Women. Front Genet 2022; 13:866062. [PMID: 35495140 PMCID: PMC9047995 DOI: 10.3389/fgene.2022.866062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
Sequencing technologies can inform individuals’ risks for multiple conditions, supporting population-level screening approaches. Prior research examining interest in genetic testing has not generally examined the context of population-based approaches offered in routine healthcare or among ethnically diverse populations. Cancer predisposition testing and carrier screening could be offered broadly to women of reproductive age. This study therefore examined interest in these tests when offered as part of routine care, and predictors of interest, among an ethnically diverse sample of women aged 20–35. We conducted an online English-language survey of 450 women; 39% identified as Latina. We examined predictors of interest for two outcomes, interest in testing in the next year and level of interest, in multivariable logistic regression models and stratified analyses by Latina ethnicity. More than half of respondents reported being interested in cancer predisposition testing (55%) and carrier screening (56%) in the next year; this did not differ by ethnicity. About 26% reported being very interested in cancer predisposition testing and 27% in carrier screening. Latina respondents (32%) were more likely to be very interested in cancer predisposition testing than non-Latina respondents (22%; p < 0.03). In multivariable models, having higher worry about genetic risks, higher genetic knowledge, and higher perceived importance of genetic information were associated with higher interest across multiple models. Predictors of interest were generally similar by ethnicity. Our findings show substantial interest in both cancer predisposition testing and carrier screening among young women as part of routine healthcare with similar interest between Latina and non-Latina women. Efforts to broadly offer such testing could be important in improving access to genetic information. It will be critical to develop tools to help healthcare providers communicate about genetic testing and to address the needs of those who have less prior knowledge about genetics to support informed decision making.
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Affiliation(s)
- Kimberly A. Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Kimberly A. Kaphingst,
| | - Jemar R. Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Alexis Vega
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Wendy K. Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
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12
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Omorodion J, Dowsett L, Clark RD, Fraser J, Abu-El-Haija A, Strong A, Wojcik MH, Bryant AS, Gold NB. Delayed diagnosis and racial bias in children with genetic conditions. Am J Med Genet A 2022; 188:1118-1123. [PMID: 35037400 PMCID: PMC10064482 DOI: 10.1002/ajmg.a.62626] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/05/2021] [Indexed: 11/07/2022]
Abstract
As more therapeutics for genetic conditions become available, the need for timely and equitable genetic diagnosis has become urgent. Using clinical cases, we consider the health system-, provider-, and patient-level factors that contribute to the delayed diagnosis of genetic conditions in pediatric patients from minority populations, leading to health disparities between racial groups. We then provide suggestions to address these factors, with the aim of improving minority health and access to genetic care for all children.
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Affiliation(s)
- Jacklyn Omorodion
- Boston Combined Residency Program, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.,Harvard Medical School Genetics Training Program, Harvard Medical School, Boston, Massachusetts, USA
| | - Leah Dowsett
- Department of Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawai'i, USA.,Kapi'olani Medical Specialists, Honolulu, Hawai'i, USA
| | - Robin D Clark
- Division of Medical Genetics, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jamie Fraser
- Division of Genetics and Metabolism, Rare Disease Institute, Children's National Hospital, Washington, District of Columbia, USA
| | - Aya Abu-El-Haija
- Division of Genetics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Alanna Strong
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Monica H Wojcik
- Division of Genetics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Allison S Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina B Gold
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Caffrey RG. Advocating for equitable management of hereditary cancer syndromes. J Genet Couns 2022; 31:584-589. [PMID: 35032082 DOI: 10.1002/jgc4.1548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
The potential for preventive medicine to lead to more equitable health outcomes exists with the inclusion of genetic testing in medicine. Because of the medical implications of genetic testing for hereditary cancer syndromes and the financial cost attached to recommended management, ensuring equitable access to cancer screening and prevention must be made a priority. For patients with Hereditary Breast and Ovarian Cancer (HBOC) syndrome, the benefits of early detection and prevention are clear, significant, and create the opportunity to provide more equitable, personalized, preventive healthcare. Thus, for genetics providers who offer testing access for their patients, it is important to reflect on the ethical responsibility of advocating for access to appropriate management. Cancer genetic counselors can advocate for health equity by providing thorough pre-test genetic counseling, collaborating with other disciplines to coordinate care, lobbying state, and national representatives to pass legislation promoting health equity, and developing a management clinic that helps to ensure follow-up. Equitable access to and benefit from hereditary cancer risk management must be achieved in the pursuit of personalized preventive medicine.
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14
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Dillon J, Ademuyiwa FO, Barrett M, Moss HA, Wignall E, Menendez C, Hughes KS, Plichta JK. Disparities in Genetic Testing for Heritable Solid-Tumor Malignancies. Surg Oncol Clin N Am 2021; 31:109-126. [PMID: 34776060 DOI: 10.1016/j.soc.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Genetic testing offers providers a potentially life saving tool for identifying and intervening in high-risk individuals. However, disparities in receipt of genetic testing have been consistently demonstrated and undoubtedly have significant implications for the populations not receiving the standard of care. If correctly used, there is the potential for genetic testing to play a role in decreasing health disparities among individuals of different races and ethnicities. However, if genetic testing continues to revolutionize cancer care while being disproportionately distributed, it also has the potential to widen the existing mortality gap between various racial and ethnic populations.
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Affiliation(s)
- Jacquelyn Dillon
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Foluso O Ademuyiwa
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Megan Barrett
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Haley A Moss
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA. https://twitter.com/haleyarden1
| | | | - Carolyn Menendez
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Clinical Cancer Genetics, Duke Cancer Institute, Durham, NC, USA. https://twitter.com/@CSMenendez
| | - Kevin S Hughes
- Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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15
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Pasca C, Carroll R, Cragun RT, Cragun DL. Knowledge and perceptions of the genetic counseling profession among a national cross-sectional sample of U.S. adults. J Genet Couns 2021; 31:206-217. [PMID: 34288232 DOI: 10.1002/jgc4.1473] [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: 01/18/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
Awareness of the genetic counseling (GC) profession may influence access to genetic services, yet awareness among the U.S. population is unknown. A survey of U.S. adults was conducted using age- and sex-based quotas. Participants were asked if they had heard of the GC profession and to describe what genetic counselors (GCs) do. After reading a brief description of what GCs do, participants were asked the likelihood they would request to see a genetic counselor if they were concerned about a genetic condition. We used descriptive statistics to characterize the population, logistic regression to determine factors related to awareness of the GC profession, and ordinary least squares regression to identify which factors correlated with likelihood of seeking GC services. Thematic analysis was used to code open-ended responses. Among the final sample of 543, the majority were White individuals (79.7%) with an average age of 46.5 and median income between $60,000 and $69,999. Although 20% indicated they had heard of the GC profession, further analysis of the qualitative follow-up question suggested only 13.4% understood the role of GCs (CI 10.6%-16.3%). Factors positively and significantly correlated with knowledge of the GC profession included identifying as White or female and having higher educational attainment or higher science knowledge after controlling for income, age, and political views. Approximately 45% of respondents indicated they would likely or very likely seek GC if concerned about a genetic condition. Biological sex, age, religious affiliation, science knowledge, and awareness of the GC profession were significantly correlated with likelihood of seeking GC services while controlling for race, income, educational attainment, and political views. Curiosity/interest, the perception of benefits, and trust in GCs were all major themes that emerged to explain reasons for seeking an appointment with GCs. Lack of awareness, lack of perceived benefit, and lack of trust in GCs or greater trust in other healthcare providers were reasons for not wanting a GC appointment. Despite the 50-year existence of the GC profession, awareness remains low and negative attitudes exist.
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Affiliation(s)
- Christina Pasca
- Department of Sociology, University of Tampa, Tampa, FL, USA
| | - Riley Carroll
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ryan T Cragun
- Department of Sociology, University of Tampa, Tampa, FL, USA
| | - Deborah L Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
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16
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Horrow C, Pacyna JE, Lee MK, Sharp RR. Measuring Attitudes About Genomic Medicine: Validation of the Genomic Orientation Scale (GO Scale). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1030-1037. [PMID: 34243827 DOI: 10.1016/j.jval.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Assessing public attitudes about genomic medicine is critical for anticipating patient receptivity to clinical applications of genomics. Although scholars have highlighted the importance of assessing stakeholder opinions and views regarding advances in clinical genomics, to date there has not been a robust tool for measuring these attitudes. We designed a study to evaluate the validity of an instrument we developed for measuring attitudes about genomic medicine. METHODS We used psychometric methods to validate the Genomic Orientation Scale (GO Scale). Our goal was to create an easy-to-use tool for evaluating positive and negative attitudes about genomic medicine. RESULTS We describe the validation testing of the GO Scale in a nationally representative sample of 1536 individuals residing in the United States. We report results from convergent and divergent validity testing and Rasch modeling analysis. The study produced a 26-item scale with 2 dimensions-optimism and pessimism. CONCLUSIONS The GO Scale may be used to characterize attitudinal perspectives among patients, clinicians, and the public. The GO Scale may also be useful in evaluating shifts in attitude over time, for example, following educational interventions, which has not been feasible to date.
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Affiliation(s)
- Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Minji K Lee
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
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17
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Eliciting Willingness and Beliefs towards Participation in Genetic Psychiatric Testing in Black/African American Mothers at Risk for Depression. Behav Sci (Basel) 2020; 10:bs10120181. [PMID: 33256064 PMCID: PMC7760786 DOI: 10.3390/bs10120181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Black/African American women are at high risk for depression, yet are underrepresented in psychiatric genetic research for depression prevention and treatment. Little is known about the factors that influence participation in genetic testing for Black/African American women at risk. The purpose of this study was to elicit the beliefs that underlie participation in genetic testing for depression in Black/African American mothers, a subgroup at high risk. Willingness to participate in genetic testing procedures was also determined. A qualitative, descriptive design was employed. Exactly 19 mothers aged 21–42 completed open-ended questionnaires. Directed content and descriptive analyses of the text were conducted based on the Theory of Planned Behavior. Salient beliefs included: behavioral advantages—diagnosing/detecting depression (31.6%), finding cure/treatment (21.1%); disadvantages—not finding follow-up treatment/help (21.1%); salient referents, who approves—family members (47.4%), agencies/organizations (26.3%); who disapproves—church associates (21.1%). Control beliefs included: barriers—unpleasant/difficult testing procedures (42.1%), limited knowledge about the purpose of testing (26.3%); facilitator—a convenient location (21.1%). Most mothers (89.5%) indicated willingness to participate in testing. Interventions can target families, address barriers, emphasize future benefits, and use convenient locations and community-based participatory research methods. Policies can address social determinants of participation to increase inclusion of these mothers in psychiatric genetic research.
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18
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Borno HT, Odisho AY, Gunn CM, Pankowska M, Rider JR. Disparities in precision medicine-Examining germline genetic counseling and testing patterns among men with prostate cancer. Urol Oncol 2020; 39:233.e9-233.e14. [PMID: 33158741 DOI: 10.1016/j.urolonc.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study sought to examine whether germline genetic counseling and testing were employed differentially among men with prostate cancer by race and/or ethnicity and other social factors. METHODS In this retrospective analysis, all patients with prostate cancer listed as a visit diagnosis during the study period (April 2011 to August 2020) were identified from electronic health records. Patient characteristics were collected along with genetic counselor visits and germline genetic testing results in electronic health records. Multivariable analyses were performed with the primary outcome defined as the receipt of a genetic counseling visit and receipt of genetic testing. RESULTS A total of 14,610 patients with a prostate cancer diagnosis code were identified. The majority of patients were White (72%), aged >=65 years (62.7%), English-speaking (95%), married (71.4%), and publicly insured (58.7%). A total of 667 patients completed an appointment with a genetic counselor. A total of 439 patients received germline genetic test result, of whom 403 (91.8%) had also completed an appointment with a genetic counselor. Patients that were 65 years or older (adjusted odds ratio 0.53, 95%CI 0.44-0.65) and non-English proficient (adjusted odds ratio 0.71, 95%CI 0.42-1.21) were less likely to receive genetic counseling. Receiving genetic counseling was the strongest independent predictor of receipt of genetic testing. CONCLUSIONS The results of the current study highlight that the role of social factors in contributing to disparities in genetic counseling and testing among men with prostate cancer. These results underscore the importance of developing novel strategies to tackle contributors of observed disparities including language, age, and insurance status.
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Affiliation(s)
- Hala T Borno
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, CA.
| | - Anobel Y Odisho
- Department of Urology, University of California, San Francisco, CA; Center for Digital Health Innovation, University of California, San Francisco, CA
| | - Christine M Gunn
- Department of Medicine, Boston University School of Medicine, Section of General Internal Medicine, Boston, MA; Department of Health Law, Boston University School of Public Health, Policy, and Management, Boston, MA
| | - Magdalena Pankowska
- Department of Medicine, Boston University School of Medicine, Section of General Internal Medicine, Boston, MA
| | - Jennifer R Rider
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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19
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Chavez-Yenter D, Chou WYS, Kaphingst KA. State of recent literature on communication about cancer genetic testing among Latinx populations. J Genet Couns 2020; 30:911-918. [PMID: 33142015 DOI: 10.1002/jgc4.1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
Cancer-related genetic testing (hereafter CGT) has transformed cancer prevention, treatment, and care. Researchers debate whether diffusion and use of genetic testing will reduce or widen cancer health disparities through effects on improving or worsening cancer-related mortality, morbidity, and outcomes that disproportionately affect racial and ethnic minority populations. Cancer disparities by race and ethnicity have been associated with social determinants of health and healthcare access and experience. However, little research has explored how communication about CGT may contribute to these disparities. As such, the goal of this study was to characterize the literature published between 2010 and 2017 on communication about CGT among Latinx populations through a secondary analysis of papers identified in a larger scoping review. We found thirteen (2.5%) of 513 papers in the parent scoping review had over 50% Latinx representation; only nine of these (69%) had fully Latinx comprised study cohorts. The majority of the 13 identified studies (n = 9) were conducted to assess knowledge and attitudes regarding CGT. Most studies included services or materials in both Spanish and English. Few studies assessed language preference or acculturation or compared outcomes across sub-ethnicities. We identified opportunities for researchers to explore differences in outcomes by language preference and acculturation, and between sub-ethnicities in future studies. Leveraging a greater understanding of the heterogeneity within the Latinx population will allow genetics researchers and providers to improve utilization of CGT and therein health outcomes to advance health equity.
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Affiliation(s)
- Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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20
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Adams EJ, Asad S, Reinbolt R, Collier KA, Abdel-Rasoul M, Gillespie S, Chen JL, Cherian MA, Noonan AM, Sardesai S, VanDeusen J, Wesolowski R, Williams N, Shapiro CL, Macrae ER, Pilarski R, Toland AE, Senter L, Ramaswamy B, Lee CN, Lustberg MB, Stover DG. Metastatic breast cancer patient perceptions of somatic tumor genomic testing. BMC Cancer 2020; 20:389. [PMID: 32375690 PMCID: PMC7201768 DOI: 10.1186/s12885-020-06905-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To assess metastatic breast cancer (MBC) patient psychological factors, perceptions, and comprehension of tumor genomic testing. METHODS In a prospective, single institution, single-arm trial, patients with MBC underwent next-generation sequencing at study entry with sequencing results released at progression. Patients who completed surveys before undergoing sequencing were included in the present secondary analysis (n = 58). We administered four validated psychosocial measures: Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, Trust in Physician Scale, and Communication and Attitudinal Self-Efficacy scale for Cancer. Genetic comprehension was assessed using 7-question objective and 6-question subjective measures. Longitudinal data were assessed (n = 40) using paired Wilcoxon signed rank and McNemar's test of agreement. RESULTS There were no significant differences between the beginning and end of study in depression, anxiety, physician trust, or self-efficacy (median time on study: 7.6 months). Depression and anxiety were positively associated with each other and both negatively associated with self-efficacy. Self-efficacy decreased from pre- to post-genomic testing (p = 0.05). Objective genetics comprehension did not significantly change from pre- to post-genomic testing, but patients expressed increased confidence in their ability to teach others about genetics (p = 0.04). Objective comprehension was significantly lower in non-white patients (p = 0.02) and patients with lower income (p = 0.04). CONCLUSIONS This is the only study, to our knowledge, to longitudinally evaluate multiple psychological metrics in MBC as patients undergo tumor genomic testing. Overall, psychological dimensions remained stable over the duration of tumor genomic testing. Among patients with MBC, depression and anxiety metrics were negatively correlated with patient self-efficacy. Patients undergoing somatic genomic testing had limited genomic knowledge, which varied by demographic groups and may warrant additional educational intervention. CLINICAL TRIAL INFORMATION NCT01987726, registered November 13, 2013.
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Affiliation(s)
- Elizabeth J Adams
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Sarah Asad
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Raquel Reinbolt
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hospital Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Katharine A Collier
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Susan Gillespie
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - James L Chen
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Mathew A Cherian
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Anne M Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Sagar Sardesai
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Jeffrey VanDeusen
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Nicole Williams
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | | | | | - Robert Pilarski
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
- Department of Cancer Biology & Genetics and Department of Internal Medicine, Division of Human Cancer Genetics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Amanda E Toland
- Department of Cancer Biology & Genetics and Department of Internal Medicine, Division of Human Cancer Genetics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Leigha Senter
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
- Department of Cancer Biology & Genetics and Department of Internal Medicine, Division of Human Cancer Genetics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Bhuvaneswari Ramaswamy
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Clara N Lee
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University, OH, Columbus, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA
| | - Daniel G Stover
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA.
- Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
- Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, USA.
- Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 512, Columbus, OH, 43210, USA.
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21
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Yeh VM, Bergner EM, Bruce MA, Kripalani S, Mitrani VB, Ogunsola TA, Wilkins CH, Griffith DM. Can Precision Medicine Actually Help People Like Me? African American and Hispanic Perspectives on the Benefits and Barriers of Precision Medicine. Ethn Dis 2020; 30:149-158. [PMID: 32269456 DOI: 10.18865/ed.30.s1.149] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To better understand African American and Hispanic perspectives on the potential benefits of precision medicine, along with the potential barriers that may prevent precision medicine from being equally beneficial to all. We also sought to identify if there were differences between African American and Hispanic perspectives. Design Six semi-structured focus groups were conducted between May 2017 and February 2018 to identify benefits and barriers to precision medicine. Three groups occurred in Nashville, TN with African American participants and three groups occurred in Miami, FL with Hispanic participants. Setting At community-based and university sites convenient to community partners and participants. Participants A total of 55 individuals participated (27 in Nashville, 28 in Miami). The majority of participants were women (76.5%) and the mean age of participants was 56.2 years old. Results Both African Americans and Hispanics believed precision medicine has the potential to improve medicine and health outcomes by individualizing care and decreasing medical uncertainty. However, both groups were concerned that inadequacies in health care institutions and socioeconomic barriers would prevent their communities from receiving the full benefits of precision medicine. African Americans were also concerned that the genetic and non-genetic personal information revealed through precision medicine would make African Americans further vulnerable to provider racism and discrimination in and outside of health care. Conclusions While these groups believed precision medicine might yield benefits for health outcomes, they are also skeptical about whether African Americans and Hispanics would actually benefit from precision medicine given current structural limitations and disparities in health care access and quality.
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Affiliation(s)
- Vivian M Yeh
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M Bergner
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN
| | - Marino A Bruce
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN.,Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN.,Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Victoria B Mitrani
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL
| | | | - Consuelo H Wilkins
- Department of Internal Medicine, Meharry Medical College, Nashville, TN.,Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN.,Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN
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22
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Hillyer GC, Schmitt KM, Reyes A, Cruz A, Lizardo M, Schwartz GK, Terry MB. Community education to enhance the more equitable use of precision medicine in Northern Manhattan. J Genet Couns 2020; 29:247-258. [PMID: 32157769 DOI: 10.1002/jgc4.1244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/30/2022]
Abstract
Focusing screening and treatment to those most likely to benefit is the promise of precision medicine but inequitable distribution of precision medicine innovations may exacerbate health disparities. We investigated whether complex genomic concepts can be successfully communicated to diverse populations. Incorporating principles of Community-based Participatory Research, we created a precision medicine curriculum tailored to the needs of our predominantly Hispanic community. We administered the curriculum over 26 months, assessed pre- and post-test comprehension of 8 genetics-related terms, and compared comprehension differences based on demography and health literacy. In total, 438 individuals completed pre-/post-test assessments. At pre-test, 45.6% scored ≥75% across eight major constructs; 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for 'mutation' (55% to 78%) and 'sporadic' (34% to 59%). Mean pre-test comprehension scores (≥75%) were lower for Spanish versus. English speakers; mean post-test scores were equivalent. No heterogeneity by demographics or health literacy was observed. We demonstrate that a brief community educational program can improve knowledge of complex genomic concepts. Interventions to increase understanding of genomic concepts underlying precision medicine are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.
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Affiliation(s)
- Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | - Andria Reyes
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Alejandro Cruz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
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23
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McKinney LP, Gerbi GB, Caplan LS, Claridy MD, Rivers BM. Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection. J Genet Couns 2020; 29:494-504. [PMID: 32103577 DOI: 10.1002/jgc4.1228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.
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Affiliation(s)
- Lawrence P McKinney
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gemechu B Gerbi
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Lee S Caplan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mechelle D Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brian M Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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24
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Savich RD, Tigges BB, Rios LI, McCloskey J, Tollestrup K, Annett RD. Willingness of women to participate in obstetrical and pediatric research involving biobanks. J Community Genet 2019; 11:215-223. [PMID: 31782046 DOI: 10.1007/s12687-019-00446-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/12/2019] [Indexed: 01/06/2023] Open
Abstract
Use of biobanks for future genetic/genomic testing has increased. Biospecimens are increasingly being collected from infants/children; however, little is known about attitudes towards collection of biospecimens from postpartum women and their child. Using a hypothetical consent, this study investigated willingness to participate and attitudes, beliefs, and concerns related to consent materials requesting the biobanking genetic samples. A cross-sectional mixed methods design included women who reviewed a hypothetical consent related to biobanking genetic samples. Women were asked about their willingness to participate, followed by a focus group about biobanks and genetic/genomic testing. Post-focus group questionnaires assessed willingness to participate, the influence of study characteristics, and attitudes about genetic testing. Women (N = 37) were 29.0± 7.3 years of age (range 19-44); 51% had children and 28% were currently pregnant. A total of 46% were Hispanic (H), 38% were White non-Hispanic (WNH), and 16% were Native American (NA). Seventy-six percent (28/37) initially indicated that they would participate in the hypothetical study. Race and ethnicity impacted whether women would participate. Fewer NA women indicated that they would participate compared with H women and with WNH women (p < 0.02). Age, pregnancy status, having children, education level, insurance status, and income had no impact on participation decision and willingness to biobank specimens. NA and H women indicated that they were less likely than WNH women to agree to participate in a long-term biobank study. Given the importance of determining the genetic influence of health and disease, it is critical to attend to the questions and concerns of minority women regarding genetic studies.
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Affiliation(s)
- Renate D Savich
- Pediatrics, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216-4505, USA
| | - Beth B Tigges
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | | | - Joanne McCloskey
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kristine Tollestrup
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Robert D Annett
- Pediatrics, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216-4505, USA.
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25
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Abstract
Uptake of prenatal genetic testing (PGT) is low among those with sickle cell disease (SCD). This study evaluated the association of knowledge and attitudes towards prenatal genetic counseling (PGC), awareness of posttesting intervention options and omission bias with attitudes towards PGT. In addition, we explored changes among knowledge, attitudes, and awareness of options following exposure to an educational, clinical vignette among parents of children with SCD. Parents (n=44) completed a questionnaire and an educational, clinical vignette presenting a detailed account of a pregnant woman with sickle cell trait seeking PGT and PGC was read to each participant. t Tests, Spearman correlations, multivariable regressions, and moderation/mediation analyses were used. More positive attitudes towards PGC (P=0.01), lesser tendency of omission bias (P<0.01) and private insurance (P=0.04) were significant correlates of more positive attitudes towards PGT. Omission bias mediated the relationship of attitudes towards PGC and attitudes towards PGT (95% confidence interval: 0.13, 3.03). Awareness of options (P=0.02), knowledge of PGC (P=0.01) and knowledge of PGT (P=0.01) significantly improved after exposure to the clinical vignette. Patients and families with SCD can benefit from education about the importance of prenatal diagnosis to improve attitudes, address omission bias and promote more informed decisions of PGT.
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26
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Ewing AT, Kalu N, Cain G, Erby LH, Ricks-Santi LJ, Tetteyfio-Kidd Telemaque E, Scott DM. Factors associated with willingness to provide biospecimens for genetics research among African American cancer survivors. J Community Genet 2019; 10:471-480. [PMID: 30877487 PMCID: PMC6754482 DOI: 10.1007/s12687-019-00411-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/05/2019] [Indexed: 11/25/2022] Open
Abstract
This study evaluated factors associated with willingness to provide biospecimens for cancer genetic research among African American cancer survivors. A total of 200 African American adults diagnosed with breast, colon, and/or prostate cancers completed a self-administered survey. Family history information, beliefs about cancer research, cancer genetics and disparities knowledge, willingness to provide a biospecimen, and demographics were obtained. Chi-square, independent samples t tests, and logistic regression analyses were performed. Overall, 79% of this sample was willing to provide a biospecimen for cancer genetics research. Independent associations of willingness to provide a biospecimen existed among demographics (males (p = 0.041)), those who believed in the importance of genetic causes of cancer (p < 0.001), individuals who believe it is important to participate in genetics research (p < 0.001), and those who indicated they would participate in genetics research to help future generations (p = 0.026). Overall, 12.5-56% of participants demonstrated some level of genetics and cancer disparities. This study identified factors that may be incorporated into future research interventions to engage the African American cancer population in cancer genetics biobanking research.
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Affiliation(s)
| | - Nnenna Kalu
- College of Medicine Alcohol Research Center, Howard University, Washington, DC USA
| | - Gloria Cain
- College of Medicine Alcohol Research Center, Howard University, Washington, DC USA
| | - Lori H. Erby
- Genetic Counseling Training Program, Johns Hopkins University/National Human Genome Research Institute (JHU/NHGRI), 31 Center Dr B1B36, Bethesda, MD USA
| | - Luisel J. Ricks-Santi
- Department of Cancer Research Center, Hampton University Cancer Center, Hampton, VA USA
| | | | - Denise M. Scott
- College of Medicine Alcohol Research Center, Howard University, Washington, DC USA
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27
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Withers M, Sayegh P, Rodriguez-Agudelo Y, Ernstrom K, Raman R, Montoya L, Zuno-Reyes A, Mosieri C, Matute E, Ringman JM. A mixed-methods study of cultural beliefs about dementia and genetic testing among Mexicans and Mexican-Americans at-risk for autosomal dominant Alzheimer's disease. J Genet Couns 2019; 28:921-932. [PMID: 31207006 PMCID: PMC7500864 DOI: 10.1002/jgc4.1133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
Trials to prevent autosomal dominantly inherited Alzheimer's disease (ADAD) are critical and timely. However, cultural beliefs about AD and genetic testing may preclude informed consent and participation, especially among racial/ethnic minorities. This mixed-methods study examines cultural beliefs about AD and genetic screening among at-risk populations of Mexican heritage. We surveyed 86 Mexican and 37 Mexican-American family members of patients with ADAD and interviewed 18 respondents in Mexico to explore perceptions and knowledge regarding AD and genetic testing. While most respondents understood that AD is inherited in their families, they also had limited understanding of the genetic mechanisms behind AD. Many believed that AD is a normal part of aging or that it is a mental illness caused by bad habits. However, beliefs that AD is caused by a curse or God's will were uncommon. The interviews demonstrated that very few at-risk respondents understood their own risk for harboring the mutation causing AD in their family. Once informed, most expressed a strong interest in genetic testing, largely motivated by the desire to be better prepared for the development of AD. Health professionals treating and investigators enrolling members from families with ADAD cannot assume that they fully understand the nature of the illness; therefore, providers should provide comprehensive information about ADAD and genetic testing.
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Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Philip Sayegh
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Karin Ernstrom
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Lucy Montoya
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | | | - Chizoba Mosieri
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Esmeralda Matute
- Institute of Neurosciences, University of Guadalajara, Guadalajara, Mexico
| | - John M. Ringman
- Department of Neurology, University of Southern California, Los Angeles, California, USA
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28
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Boland SE, Street RL, Persky S. Weight-related genomic information and provider communication approach: looking through the lens of patient race. Per Med 2019; 16:387-397. [PMID: 31552797 DOI: 10.2217/pme-2018-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: This report explores the process of weight-related genomic information provision considering patient race as an important potential moderator of patient response. Methods: Health beliefs and perceived stigma were assessed following provision of genomic (versus behavioral) information by a virtual reality-based physician using either a supportive or directive communication style. Participants included 168 women with overweight. Results: Genomic explanations, combined with supportive communication, resulted in some improved health behavior-related and interpersonal outcomes for white patients, but not black participants. Black participants, on average, did not have diminished outcomes when provided with genomic information. Conclusion: Genomic communications may elicit more positive interpersonal responses than behavioral explanations among both majority and minority populations, but these effects may be moderated by patient race.
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Affiliation(s)
- Sarah E Boland
- Social and Behavioral Research Branch, National Human Genome Research Institute 31 Center Drive, B1B36, Bethesda, MD 20892, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, 4234 TAMU, College Station, TX 77843-4234, USA.,Department of Houston Center for Quality Care & Utilization Studies Section for Health Services Research, Baylor College of Medicine, Houston, TX 77030, USA
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute 31 Center Drive, B1B36, Bethesda, MD 20892, USA
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29
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Effect of Health Education Programme on the Knowledge of and Attitude about Sickle Cell Anaemia among Male Secondary School Students in the Jazan Region of Saudi Arabia: Health Policy Implications. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9653092. [PMID: 31428653 PMCID: PMC6683794 DOI: 10.1155/2019/9653092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
This study was conducted to develop an instructional programme on sickle cell anaemia (SCA) and test the effect of the programme on the secondary school students' knowledge of and attitude towards sickle cell anaemia in the Jazan region of Saudi Arabia. A pretest/posttest one-arm interventional study was conducted at the Faculty of Public Health and Tropical Medicine, Jazan University, with a convenience sample of 120 male students. The intervention consisted of two interactive sessions about sickle cell anaemia and premarital screening. The mean student knowledge score was 6.04 ± 3.02 on the pretest, which improved to 10.73 ± 3.47 on the posttest, with a statistically significant difference (t = 15.2, p < 0.001). There was no significant difference in the responses pertaining to attitude before and after the health education intervention. The policy implications of these findings are discussed to improve the performance of the Saudi healthcare system in dealing with this costly inherited disease.
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30
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Rini C, Henderson GE, Evans JP, Berg JS, Foreman AKM, Griesemer I, Waltz M, O'Daniel JM, Roche MI. Genomic knowledge in the context of diagnostic exome sequencing: changes over time, persistent subgroup differences, and associations with psychological sequencing outcomes. Genet Med 2019; 22:60-68. [PMID: 31312045 PMCID: PMC6946868 DOI: 10.1038/s41436-019-0600-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/19/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose People undergoing diagnostic genome-scale sequencing are expected to have better psychological outcomes when they can incorporate and act on accurate, relevant knowledge that supports informed decision making. Methods This longitudinal study used data from the NCGENES study of diagnostic exome sequencing to evaluate associations between factual genomic knowledge (measured with the University of North Carolina Genomic Knowledge Scale at three assessments from baseline to after return of results) and sequencing outcomes that reflected participants’ perceived understanding of the study and sequencing, regret for joining the study, and responses to learning sequencing results. It also investigated differences in genomic knowledge associated with subgroups differing in race/ethnicity, income, education, health literacy, English proficiency, and prior genetic testing. Results Multivariate models revealed higher genomic knowledge at baseline for non-Hispanic Whites and those with higher income, education, and health literacy (ps<.001). These subgroup differences persisted across study assessments despite a general increase in knowledge among all groups. Greater baseline genomic knowledge was associated with lower test-related distress (p=.047) and greater perceived understanding of diagnostic genomic sequencing (ps .04 to <.001). Conclusion Findings extend understanding of the role of genomic knowledge in psychological outcomes of diagnostic exome sequencing, providing guidance for additional research and interventions.
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Affiliation(s)
- Christine Rini
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Gail E Henderson
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James P Evans
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann Katherine M Foreman
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ida Griesemer
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret Waltz
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M O'Daniel
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Myra I Roche
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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31
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Saylor KW, Ekunwe L, Antoine-LaVigne D, Sellers DE, McGraw S, Levy D, Splansky GL, Joffe S. Attitudes Toward Genetics and Genetic Testing Among Participants in the Jackson and Framingham Heart Studies. J Empir Res Hum Res Ethics 2019; 14:262-273. [PMID: 31068049 DOI: 10.1177/1556264619844851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants' attitudes toward genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (n = 960), Framingham Heart Study (n = 955), and Framingham Heart Study-Omni Cohort (n = 160). Based on a three-question attitude scale, most participants had positive attitudes toward genetic testing (median score = 4.3-5/5). Participants were also asked to select words to describe their attitudes toward genetics. More respondents endorsed the positive words "hopeful" (60%-70%), "optimistic" (44%-64%), "enthusiastic" (35%-43%), or "excited" (28%-30%) than the negative words "cautious" (35%-38%), "concerned" (25%-55%), "worried" (6%-13%), "pessimistic" (2%-5%), or "horrified" (1%-5%). Characteristics associated with favorable attitudes were greater genetics knowledge, higher subjective numeracy, experience with genetic testing, less frequent religious attendance, and not being employed. These findings demonstrate variation in attitudes even among participants in long-standing cohort studies, indicating a need for ongoing participant engagement and education.
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Affiliation(s)
| | | | | | | | | | - Daniel Levy
- 5 Framingham Heart Study, Framingham, MA, USA.,6 National Institutes of Health, Bethesda, MD, USA
| | | | - Steven Joffe
- 7 University of Pennsylvania, Philadelphia, PA, USA.,8 Children's Hospital of Philadelphia, Philadelphia, PA, USA
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32
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Horrow C, Pacyna JE, Sutton EJ, Sperry BP, Breitkopf CR, Sharp RR. Assessing optimism and pessimism about genomic medicine: Development of a genomic orientation scale. Clin Genet 2019; 95:704-712. [DOI: 10.1111/cge.13535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Caroline Horrow
- Biomedical Ethics Research ProgramMayo Clinic Rochester Minnesota
| | - Joel E. Pacyna
- Biomedical Ethics Research ProgramMayo Clinic Rochester Minnesota
| | - Erica J. Sutton
- Biomedical Ethics Research ProgramMayo Clinic Rochester Minnesota
| | - Beau P. Sperry
- Biomedical Ethics Research ProgramMayo Clinic Rochester Minnesota
| | | | - Richard R. Sharp
- Biomedical Ethics Research ProgramMayo Clinic Rochester Minnesota
- Center for Individualized MedicineMayo Clinic Rochester Minnesota
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33
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Canedo JR, Miller ST, Myers HF, Sanderson M. Racial and ethnic differences in knowledge and attitudes about genetic testing in the US: Systematic review. J Genet Couns 2019; 28:587-601. [PMID: 30663831 DOI: 10.1002/jgc4.1078] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
Precision medicine has grown over the past 20 years with the availability of genetic tests and has changed the one-size-fits-all paradigm in medicine. Precision medicine innovations, such as newly available genetic tests, could potentially widen racial and ethnic disparities if access to them is unequal and if interest to use them differs across groups. The objective of this systematic review was to synthesize existing evidence on racial and ethnic differences in knowledge of and attitudes toward genetic testing among adult patients and the general public in the US, focusing on research about the use of genetic testing in general, not disease-specific tests. Twelve articles published in 1997-2017 met inclusion and exclusion criteria, with 10 including knowledge variables and seven including attitude variables. Studies found consistent patterns of lower awareness of genetic testing in general among non-Whites compared to Whites, lower factual knowledge scores among Blacks and Hispanics/Latinos, and mixed findings of differences in awareness of direct-to-consumer (DTC) genetic testing or the term precision medicine. Blacks, Hispanics/Latinos, and non-Whites generally had more concerns about genetic testing than Whites. The findings suggest that patients and the general public need access to culturally appropriate educational material about the use of genetic testing in precision medicine.
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Affiliation(s)
- Juan R Canedo
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee
| | | | - Hector F Myers
- Center for Medicine, Health and Society, Vanderbilt University, Nashville, Tennessee
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee
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Lewis KL, Facio FM, Berrios CD. Using the diffusion of innovations model to guide participant engagement in the genomics era. J Genet Couns 2019; 28:419-427. [PMID: 30653790 DOI: 10.1002/jgc4.1090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 12/12/2022]
Abstract
Exome and genome sequencing (EGS) are increasingly the genetic testing modalities of choice among researchers owing to their ready availability, low cost, and large data output. Recruitment of larger, more diverse cohorts into long-term studies with extensive data collection is fundamental to the success of EGS research and to the widespread benefit of genomic medicine to various populations. Effective engagement will be critical to meeting this demand. The Diffusion of Innovation (DOI) model provides a framework for how new technologies are adopted in communities, including antecedents of an individual's decision to adopt the technology, how the technology's attributes influence its acceptability, the predictors of sustained use of that technology, and its diffusion through society. We apply the DOI model to frame participant engagement in EGS research and to guide the proposal of potential strategies that aim to overcome forecasted challenges. Finally, we suggest a variety of ways genetic counselors can apply their skills and training to the development and implementation of these strategies.
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Affiliation(s)
- Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Flavia M Facio
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Courtney D Berrios
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
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Machirori M, Patch C, Metcalfe A. Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge. Eur J Med Genet 2018; 62:376-384. [PMID: 30550831 DOI: 10.1016/j.ejmg.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/30/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022]
Abstract
Within the field of breast cancer care, women concerned about their family history are offered genetic testing and subsequent treatment options based on several factors which include but are not limited to personal and family cancer disease histories and clinical guidelines. Discussions around decision-making in genetics in Black and Minority Ethnic (BME) groups are rarely documented in literature, and information regarding interactions with genetics services is usually discussed and linked to lack of scientific knowledge. As such, counselling sessions based only on scientific and medical information miss out the many reasons participants consider in making health decisions, information which can be used to encourage BME women to engage in cancer genetics services. 10 BME women with a mixed personal and family history of breast and ovarian cancer backgrounds, were interviewed in a study exploring issues of knowledge about familial breast cancer syndromes, to understand how they created and used familial knowledge for health decisions, with a particular focus on attitudes towards risk reducing strategies. Study results show that our participants are not unique in the ways they make decisions towards the use of cancer genetics and risk reduction strategies and as such, there are no specific ethnically defined pathways for decision-making. Our participants demonstrated mixed biomedical, social and individual cultural reasons for their decision-making towards risk reduction surgeries and treatment options which are similar to women from different ethnicities and are individual rather than group-specific. Narratives about suspicion of scientific utility of genetic knowledge, the perceived predictive value of mutations for future cancers or the origin of mutations and family disease patterns feature heavily in how participants evaluated genetic information and treatment decisions. The diversity of results shows that our participants are interested in engaging with genetic information but use multiple sources for evaluating the extent of involvement in genetic services and the place of genetic information and treatment options for themselves and their families. Genetic information is considered within various bio-social scenarios before decision-making for risk reduction is undertaken. BME women are shown to undertake evaluative processes which clinicians are encouraged to explore for better patient support. Continuing to focus on links between superficial and un-representative meanings of ethnicity, ethnic identity and attitudes and behaviours by only searching for differences between ethnic groups, are unhelpful in further understanding how women from those diverse backgrounds make decisions towards risk reduction interventions. Future research must find ways of investigating and understanding populations in ways that are not focussed solely on ethnic differences but on how meaning is created out of social circumstances and experiences.
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Affiliation(s)
- Mavis Machirori
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom.
| | - Christine Patch
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom
| | - Alison Metcalfe
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom; Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
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Gordon EJ, Amόrtegui D, Blancas I, Wicklund C, Friedewald J, Sharp RR. African American Living Donors' Attitudes About APOL1 Genetic Testing: A Mixed Methods Study. Am J Kidney Dis 2018; 72:819-833. [PMID: 30360961 PMCID: PMC6252162 DOI: 10.1053/j.ajkd.2018.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/24/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE & OBJECTIVE African American live kidney donors ("donors") have a greater risk for kidney failure than European American donors. Apolipoprotein L1 gene (APOL1) variants in African Americans may be associated with this disparity. STUDY DESIGN Cross-sectional mixed-methods design. SETTING & PARTICIPANTS African American donors at 1 transplantation center. ANALYTICAL APPROACH Semistructured interviews assessed attitudes about APOL1 genetic testing, willingness to undergo APOL1 testing, hypothetical decisions about donating with 2 APOL1 variants, and demographics. Surveys assessed perceptions of ethnic identity and genetics knowledge. Interview transcriptions were analyzed using thematic analysis. Survey data were analyzed using descriptive statistics. RESULTS 23 donors participated in semistructured interviews. Most (96%) reported that transplantation centers should routinely offer APOL1 genetic testing to all African American potential donors. Most (87%) would have been willing to undergo APOL1 testing before donating. Although study participants noted that APOL1 testing may deter African American potential donors from donating, most (61%) would have donated even if they had 2 high-risk APOL1 variants. Several themes emerged. Study participants believed that APOL1 testing was beneficial for providing information to help donors make informed donation decisions. Participants expressed concern about APOL1 variants placing donors at harm for kidney failure, and therefore valued taking preventive health measures. Participants believed that potential donors would experience psychological distress from learning that they have 2 gene variants and could harm their recipients. Participants were apprehensive about insurance coverage and costs of APOL1 testing and feared that APOL1 genetic test results could discriminate against African Americans. LIMITATIONS Findings may not be generalizable to African American potential donors. CONCLUSIONS Findings suggest that African American donors support APOL1 genetic testing yet fear that APOL1 variants and genetic testing could adversely affect donors' health and ethnic identity. Transplantation centers using APOL1 genetic testing should address African American donors' concerns about APOL1 genetic testing to optimize future donors' informed consent practices.
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Affiliation(s)
- Elisa J Gordon
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Daniela Amόrtegui
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Isaac Blancas
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine Wicklund
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Friedewald
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Roberts LW, Dunn LB, Kim JP, Rostami M. Perspectives of psychiatric investigators and IRB chairs regarding benefits of psychiatric genetics research. J Psychiatr Res 2018; 106:54-60. [PMID: 30273801 PMCID: PMC6428055 DOI: 10.1016/j.jpsychires.2018.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 11/24/2022]
Abstract
There is hope that psychiatric genetics inquiry will provide important insights into the origins and treatment of mental illness given the burden of these conditions. We sought to examine perspectives of psychiatric genetic investigators regarding the potential benefits of genetic research in general and the potential benefits of genetic research for the diagnosis and treatment of mental illnesses specifically. We compared investigator attitudes with those of chairs of Institutional Review Boards (IRBs) entrusted with evaluating the benefits and risks of human research studies. Two groups directly engaged with the conduct and oversight of psychiatric genetic research were examined (psychiatric investigators, n = 203; IRB Chairs, n = 183). Participants rated 15 survey items regarding current and future benefits of general genetic research, possible benefits of psychiatric genetic research, and the importance to society of genetic vs. non-genetic research examining causes and treatments of illnesses. Investigators and IRB Chairs strongly endorsed the future benefits of general genetic research for society and for the health of individuals; compared to IRB Chairs, investigators were more positive about these benefits. Even after adjusting for demographic variables, psychiatric genetic investigators were significantly more optimistic about genetic research compared with IRB Chairs. Both groups were moderately optimistic about the possible benefits of genetic research related to mental illness. Greater optimism was seen regarding new or personalized medications for mental illnesses, as well as genetic predictive testing of mental illnesses. Greater precision and circumspection about the potential benefits of psychiatric genetic research are needed.
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Affiliation(s)
- Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5717, USA.
| | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Maryam Rostami
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
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Kanga-Parabia A, Gaff C, Flander L, Jenkins M, Keogh LA. Discussions about predictive genetic testing for Lynch syndrome: the role of health professionals and families in decisions to decline. Fam Cancer 2018; 17:547-555. [PMID: 29464398 PMCID: PMC6102092 DOI: 10.1007/s10689-018-0078-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Unaffected relatives of individuals with Lynch syndrome can be offered predictive genetic testing to guide surveillance recommendations. The decision-making process of those who decline testing, particularly those who do not attend a clinical genetics service, is poorly understood. We have addressed this gap by interviewing 33 individuals from Lynch syndrome mutation-carrying families, unaffected by cancer, who declined predictive genetic testing. Here, we analyse the data provided by 20 participants who unequivocally declined testing. Those who indicated they did not have enough information to make a decision or intended to undergo testing in the future were excluded. Analysis revealed that few decliners discussed their decision with general practitioners or genetic counsellors. Family members were commonly involved to varying degrees, with participants either (1) making group decisions with family members, (2) feeling persuaded by family members to either accept or decline testing, (3) discussing the test but making their own decision. A minority did not discuss testing with family members while making their decision. This research reveals the health communication activities of an understudied group, those declining predictive testing, and indicates that for many, health professionals play a minor role in the decision compared to family.
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Affiliation(s)
- Anaita Kanga-Parabia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Melbourne, VIC, 3010, Australia
| | - Clara Gaff
- Departments of Paediatrics and Medicine, The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Melbourne, VIC, 3010, Australia.
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Williams JR, Yeh VM, Bruce MA, Szetela C, Ukoli F, Wilkins CH, Kripalani S. Precision Medicine: Familiarity, Perceived Health Drivers, and Genetic Testing Considerations Across Health Literacy Levels in a Diverse Sample. J Genet Couns 2018; 28:10.1007/s10897-018-0291-z. [PMID: 30105426 PMCID: PMC6374217 DOI: 10.1007/s10897-018-0291-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/06/2018] [Indexed: 01/25/2023]
Abstract
A clear awareness of a patient's knowledge, values, and perspectives is an important component of effective genetic counseling. Advances in precision medicine, however, have outpaced our understanding of patient perceptions of this new approach. Patient views may differ across the three domains of precision medicine (genetics, behavioral, and environmental determinants of health), ethnic/racial groups, and health literacy levels. This study describes and compares group differences in familiarity, perceptions, and preferences for precision medicine in a diverse sample. Between 2016 and 2017, 252 participants completed a 10-15-min survey in three primary care clinics in Florida and Tennessee. The final sample was 42.5% African American/Black, 25.8% Hispanic/Latino, 25.0% White, and 6.7% other ethnicity/race. Less than a quarter of participants reported being familiar with the term "precision medicine," but were more familiar with basic genetic terms. Participants with higher health literacy reported greater familiarity with terms (p ≤ .003). African Americans/Black participants were more likely to identify ethnicity/race and discrimination as influencing their health (p ≤ .004). When deciding to get a genetic test, individuals across ethnic/racial groups shared similar considerations. Those with higher health literacy, however, gave significantly greater importance to provider trust (p ≤ .008). Given the recent emergence of precision medicine, at present there may be limited differences in patient perceptions across ethnic/racial groups. Culturally sensitive efforts, tailored to health literacy level, may aid equitable precision medicine uptake.
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Affiliation(s)
- Jessica R Williams
- School of Nursing, University of North Carolina at Chapel Hill, 5004 Carrington Hall, Campus Box 7460, Chapel Hill, NC, 27599-7460, USA.
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Vivian M Yeh
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marino A Bruce
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Szetela
- Department of Professional and Medical Education, Meharry Medical College, Nashville, TN, USA
| | - Flora Ukoli
- Department of Surgery, Meharry Medical College, Nashville, TN, USA
| | - Consuelo H Wilkins
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Meharry-Vanderbilt Alliance, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Chen LS, Min J, Zhao S, Yeh YC, Huang TY. Information needs in genetic testing: A needs assessment survey among Taiwanese parents of children with autism spectrum disorders. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:902-909. [PMID: 30073847 DOI: 10.1177/1362361318778903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We conducted the first needs assessment study by examining the information needs in genetic testing for autism spectrum disorders among parents of children with autism spectrum disorders in Taiwan. Parents of children with autism spectrum disorders in 236 public elementary schools with special education services were invited to complete a survey. About two-thirds of participants (65.7%) had never heard about genetic testing for autism spectrum disorders. Yet, the majority (71.4%) expressed an interest in learning about this testing. The top three topics participants identified to assist them in making informed decisions before undergoing genetic testing (for themselves, their affected children, or other family members) were testing accuracy (79.7%), genetic causes of autism spectrum disorders (79.4%), and the link between testing and treatment (79.4%). A health education brochure (47.2%) was the most desired educational approach. Our results can be utilized to develop information and counseling materials for genetic testing for autism spectrum disorders in Taiwan as well as to address the needs of parents of children with autism spectrum disorders, particularly in informed decisions-making. Moreover, to promote better communication between the providers and parents, when discussing genetic testing for autism spectrum disorders with Taiwanese parents of children with autism spectrum disorders, healthcare professionals' priorities should be in line with the preferred topics identified in this study.
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Affiliation(s)
- Lei-Shih Chen
- 1 Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Jungkyung Min
- 1 Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Shixi Zhao
- 1 Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Yu-Chen Yeh
- 2 Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Tse-Yang Huang
- 3 Department of Special Education, National Tsing Hua University, Hsinchu, Taiwan
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Roberts MC, Taber JM, Klein WM. Engagement with Genetic Information and Uptake of Genetic Testing: the Role of Trust and Personal Cancer History. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:893-900. [PMID: 28105554 DOI: 10.1007/s13187-016-1160-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We used national survey data to (1) determine the extent to which individuals trust the sources from which they are most likely to receive information about cancer-related genetic tests (BRCA1/2, Lynch syndrome), (2) examine how level of trust for sources of genetic information might be related to cancer-related genetic testing uptake, and (3) determine whether key factors, such as cancer history and numeracy, moderate the latter association. We used cross-sectional data from the Health Information National Trends Survey. Our study sample included individuals who responded that they had heard or read about genetic tests (n = 1117). All analyses accounted for complex survey design. Although respondents trusted information from health professionals the most, they were significantly less likely to report hearing about genetic testing from such professionals than via television (p < 0.01). Regardless of source, higher levels of trust in the information source from which participants heard about genetic tests were associated with increased odds of genetic testing uptake, particularly among those with a personal cancer history. Numeracy was not associated with genetic testing uptake. Because health professionals were among the most trusted health information sources, they may serve as important brokers of genetic testing information for those with a personal cancer history.
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Affiliation(s)
- Megan C Roberts
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA.
| | - Jennifer M Taber
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - William M Klein
- The National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
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Radecki Breitkopf C, Wolf SM, Chaffee KG, Robinson ME, Lindor NM, Gordon DR, Koenig BA, Petersen GM. Attitudes Toward Return of Genetic Research Results to Relatives, Including After Death: Comparison of Cancer Probands, Blood Relatives, and Spouse/Partners. J Empir Res Hum Res Ethics 2018; 13:295-304. [PMID: 29701109 DOI: 10.1177/1556264618769165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Genetic research generates results with implications for relatives. Recommendations addressing relatives' access to a participant's genetic research findings include eliciting participant preferences about access and choosing a representative to make decisions about access upon participant incapacity/death. Representatives are likely to be blood relatives or spouse/partners (who may share genetically related children). This raises the question of whether relatives hold similar attitudes about access or divergent attitudes that may yield conflict. We surveyed pancreatic cancer biobank participants (probands) and relatives in a family registry (blood relatives and spouse/partners of probands); 1,903 (>55%) surveys were returned. Results revealed few attitudinal differences between the groups. A slightly higher proportion of blood relatives agreed with statements reflecting proband privacy. In conclusion, probands' decisions on access are likely to be accepted by relatives; in choosing a representative, probands may not face major differences in attitudes about privacy/sharing between a blood relative and a spouse/partner.
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Hickey KT, Taylor JY, Barr TL, Hauser NR, Jia H, Riga TC, Katapodi M. Nursing genetics and genomics: The International Society of Nurses in Genetics (ISONG) survey. NURSE EDUCATION TODAY 2018; 63:12-17. [PMID: 29407254 PMCID: PMC6461386 DOI: 10.1016/j.nedt.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/04/2018] [Indexed: 05/02/2023]
Abstract
BACKGROUND The International Society of Nursing in Genetics (ISONG) fosters scientific and professional development in the discovery, interpretation, and application of genomic information in nursing research, education, and clinical practice. OBJECTIVES Assess genomic-related activities of ISONG members in research, education and practice, and competencies to serve as global leaders in genomics. DESIGN Cross-sectional survey (21-items) assessing genomic-related training, knowledge, and practice. SETTINGS An email invitation included a link to the anonymous online survey. PARTICIPANTS All ISONG members (n = 350 globally) were invited to partake. METHODS Descriptive statistics and Wilcoxon Rank Sum Test for between-group comparisons. RESULTS Respondents (n = 231, 66%), were mostly Caucasian, female, with a master's degree or higher. Approximately 70% wanted to incorporate genomics in research, teaching, and practice. More than half reported high genomic competency, and over 95% reported that genomics is relevant the next 5 years. CONCLUSIONS Findings provide a foundation for developing additional educational programs for an international nursing workforce in genomics.
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Affiliation(s)
- Kathleen T Hickey
- Columbia University School of Nursing, 622 W. 168th St., New York, NY 10032, United States.
| | - Jacquelyn Y Taylor
- Yale School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States.
| | - Taura L Barr
- Valtari Bio Inc., United States; Case Western Reserve University, 8 Medical Center Drive, Morgantown, WV 26506, United States.
| | - Nicole R Hauser
- Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, United States.
| | - Haomiao Jia
- Columbia University School of Nursing, 617 W. 168th St., New York, NY 10032, United States.
| | - Teresa C Riga
- Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, United States.
| | - Maria Katapodi
- Faculty of Medicine, University of Basel, Switzerland; University of Michigan School of Nursing, 4056 Basel, Switzerland.
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Oberg JA, Ruiz J, Ali-Shaw T, Schlechtweg KA, Ricci A, Kung AL, Chung WK, Appelbaum PS, Glade Bender JL, Levine JM. Whole-Genome and Whole-Exome Sequencing in Pediatric Oncology: An Assessment of Parent and Young Adult Patient Knowledge, Attitudes, and Expectations. JCO Precis Oncol 2018; 2:1700104. [PMID: 32913997 DOI: 10.1200/po.17.00104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The complexity of results generated from whole-genome sequencing (WGS) and whole-exome sequencing (WES) adds challenges to obtaining informed consent in pediatric oncology. Little is known about knowledge of WGS and WES in this population, and no validated tools exist in pediatric oncology. Methods We developed and psychometrically evaluated a novel WGS and WES knowledge questionnaire, the Precision in Pediatric Sequencing Knowledge Questionnaire (PIPseqKQ), to identify levels of understanding among parents and young adult cancer survivors (≥ 18 years old), off therapy for at least 1 year from a single-institution pediatric oncology outpatient clinic. Participants also completed health literacy and numeracy questionnaires. All participants provided written informed consent. Results One hundred eleven participants were enrolled: 76 were parents, and 35 were young adults. Of the total cohort, 77 (69%) were female, 63 (57%) self-identified as white, and 74 (67%) self-identified as non-Hispanic. Sixty-six (59%) had less than a college degree. Adequate health literacy (n = 87; 80%) and numeracy (n = 89; 80%) were demonstrated. Internal consistency was high (Cronbach's α = .88), and test-retest reliability was greater than the 0.7 minimum requirement. Scores were highest for genetic concepts related to health and cancer and lowest for WGS and WES concepts. Health literacy and educational attainment were significantly associated with PIPseqKQ scores. Overall, participants felt the benefits of WGS and WES outweighed the potential risks. Conclusion Parents and young adult cancer survivors have some genetics knowledge, but they lack knowledge about WGS and WES. The PIPseqKQ is a reliable tool that can identify deficits in knowledge, identify perceptions of risks and benefits of WGS and WES, and help clinicians tailor their consent discussions to best fit families. The PIPseqKQ also may inform the development of educational tools to better facilitate the informed consent process in pediatric oncology.
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Affiliation(s)
- Jennifer A Oberg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jenny Ruiz
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Trisha Ali-Shaw
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Kathryn A Schlechtweg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Ricci
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew L Kung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Wendy K Chung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Paul S Appelbaum
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Julia L Glade Bender
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jennifer M Levine
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
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45
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Horowitz CR, Ferryman K, Negron R, Sabin T, Rodriguez M, Zinberg RF, Böttinger E, Robinson M. Race, Genomics and Chronic Disease: What Patients with African Ancestry Have to Say. J Health Care Poor Underserved 2018; 28:248-260. [PMID: 28238999 DOI: 10.1353/hpu.2017.0020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Variants of the APOL1 gene increase risk for kidney failure 10-fold, and are nearly exclusively found in people with African ancestry. To translate genomic discoveries into practice, we gathered information about effects and challenges incorporating genetic risk in clinical care. METHODS An academic-community-clinical team tested 26 adults with self-reported African ancestry for APOL1 variants, conducting in-depth interviews about patients' beliefs and attitudes toward genetic testing- before, immediately, and 30 days after receiving test results. We used constant comparative analysis of interview transcripts to identify themes. RESULTS Themes included: Knowledge of genetic risk for kidney failure may motivate providers and patients to take hypertension more seriously, rather than inspiring fatalism or anxiety. Having genetic risk for a disease may counter stereotypes of Blacks as non-adherent or low-literate, rather than exacerbate stereotypes. CONCLUSION Populations most likely to benefit from genomic research can inform strategies for genetic testing and future research.
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Peipins LA, Rodriguez JL, Hawkins NA, Soman A, White MC, Hodgson ME, DeRoo LA, Sandler DP. Communicating with Daughters About Familial Risk of Breast Cancer: Individual, Family, and Provider Influences on Women's Knowledge of Cancer Risk. J Womens Health (Larchmt) 2018; 27:630-639. [PMID: 29377785 DOI: 10.1089/jwh.2017.6528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Women facing complex and uncertain situations such as cancer in their families may seek information from a variety of sources to gain knowledge about cancer risk and reduce uncertainty. We describe and assess the relative importance of information sources about familial breast cancer at the individual, family, and healthcare provider levels influencing women's reporting they had enough information to speak with daughters about breast cancer. This outcome we refer to as being informed about breast cancer. MATERIALS AND METHODS Sister Study participants, a cohort of women with a family history of breast cancer, were surveyed on family cancer history, family communication, social support, and interactions with healthcare providers (n = 11,766). Adjusted percentages and 95% confidence intervals for being informed about breast cancer versus not being informed were computed for individual-, family-, and provider-level characteristics in three steps using multivariate logistic regression models. RESULTS We found 65% of women reported being informed about breast cancer while 35% did not. Having a trusted person with whom to discuss cancer concerns, having a lower versus higher perceived risk of breast cancer, having undergone genetic counseling, and being satisfied with physician discussions about breast cancer in their families were predictors of being informed about breast cancer. CONCLUSIONS Although acquiring objective risk information, such as through genetic counseling, may contribute to a basic level of understanding, communication with providers and within other trusted relationships appears to be an essential component in women's reporting they had all the information they need to talk with their daughters about breast cancer.
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Affiliation(s)
- Lucy A Peipins
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Juan L Rodriguez
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Nikki A Hawkins
- 2 National Center for Chronic Disease Prevention and Disease Promotion, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Ashwini Soman
- 3 Northrop Grumman Corporation , Information Systems, Atlanta, Georgia
| | - Mary C White
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Lisa A DeRoo
- 5 Department of Global Public Health and Primary Care, University of Bergen , Bergen, Norway
| | - Dale P Sandler
- 6 Epidemiology Branch, National Institute of Environmental Health Sciences , Durham, North Carolina
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Disclosing Genetic Risk for Coronary Heart Disease: Attitudes Toward Personal Information in Health Records. Am J Prev Med 2017; 52:499-506. [PMID: 28062272 PMCID: PMC5362329 DOI: 10.1016/j.amepre.2016.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/30/2016] [Accepted: 11/04/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Incorporating genetic risk information in electronic health records (EHRs) will facilitate implementation of genomic medicine in clinical practice. However, little is known about patients' attitudes toward incorporation of genetic risk information as a component of personal health information in EHRs. This study investigated whether disclosure of a genetic risk score (GRS) for coronary heart disease influences attitudes toward incorporation of personal health information including genetic risk in EHRs. METHODS Participants aged 45-65 years with intermediate 10-year coronary heart disease risk were randomized to receive a conventional risk score (CRS) alone or with a GRS from a genetic counselor, followed by shared decision making with a physician using the same standard presentation and information templates for all study participants. The CRS and GRS were then incorporated into the EHR and made accessible to both patients and physicians. Baseline and post-disclosure surveys were completed to assess whether attitudes differed by GRS disclosure. Data were collected from 2013 to 2015 and analyzed in 2015-2016. RESULTS GRS and CRS participants reported similar positive attitudes toward incorporation of genetic risk information in the EHR. Compared with CRS participants, participants with high GRS were more concerned about the confidentiality of genetic risk information (OR=3.67, 95% CI=1.29, 12.32, p=0.01). Post-disclosure, frequency of patient portal access was associated with positive attitudes. CONCLUSIONS Participants in this study of coronary heart disease risk disclosure overall had positive attitudes toward incorporation of genetic risk information in EHRs, although those who received genetic risk information had concerns about confidentiality.
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Chokoshvili D, Belmans C, Poncelet R, Sanders S, Vaes D, Vears D, Janssens S, Huys I, Borry P. Public Views on Genetics and Genetic Testing: A Survey of the General Public in Belgium. Genet Test Mol Biomarkers 2017; 21:195-201. [PMID: 28306397 DOI: 10.1089/gtmb.2016.0418] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS To explore the views of the Belgian public on various topics surrounding genetics and genetic testing (GT). MATERIALS AND METHODS A written questionnaire was administered to visitors of the annual cartoon festival in Knokke-Heist, Belgium, during the summer of 2014. The main theme of the festival was challenges and progress in human genetics and it was attended by more than 100,000 visitors. RESULTS The survey was completed by 1182 respondents, resulting in a demographically diverse sample with a mean age of 48.5 years. Our respondents expressed moderate interest in predictive GT, with 39.1% willing to learn about their predisposition to diseases through GT and 49.5% indicating interest in getting tested exclusively for treatable/preventable diseases. We observed higher interest in GT for reproductive purposes, such as preconception screening for recessive disorders (53.8%) and prenatal GT (60.7%). A substantial minority (46.4%) of the respondents were worried that GT could further stigmatize people with disabilities, while 39.7% believed that carrier screening for recessive diseases would lead to an inferior image of people affected by them. CONCLUSION Paying due attention to the attitudes, beliefs, and concerns of the general public is important to ensure ethically sound and socially acceptable implementation of new genetic technologies.
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Affiliation(s)
- Davit Chokoshvili
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Carmen Belmans
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Roxanne Poncelet
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Sofie Sanders
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Deborah Vaes
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Danya Vears
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Sandra Janssens
- 2 Centre for Medical Genetics Ghent, University Hospital Ghent , Ghent, Belgium
| | - Isabelle Huys
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Pascal Borry
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
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Reiff M, Bugos E, Giarelli E, Bernhardt BA, Spinner NB, Sankar PL, Mulchandani S. "Set in Stone" or "Ray of Hope": Parents' Beliefs About Cause and Prognosis After Genomic Testing of Children Diagnosed with ASD. J Autism Dev Disord 2017; 47:1453-1463. [PMID: 28229350 DOI: 10.1007/s10803-017-3067-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite increasing utilization of chromosomal microarray analysis (CMA) for autism spectrum disorders (ASD), limited information exists about how results influence parents' beliefs about etiology and prognosis. We conducted in-depth interviews and surveys with 57 parents of children with ASD who received CMA results categorized as pathogenic, negative or variant of uncertain significance. Parents tended to incorporate their child's CMA results within their existing beliefs about the etiology of ASD, regardless of CMA result. However, parents' expectations for the future tended to differ depending on results; those who received genetic confirmation for their children's ASD expressed a sense of concreteness, acceptance and permanence of the condition. Some parents expressed hope for future biomedical treatments as a result of genetic research.
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Affiliation(s)
- Marian Reiff
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Philadelphia, PA, 19104, USA. .,Counseling and Psychological Services, University of Pennsylvania, Philadelphia, PA, USA.
| | - Eva Bugos
- Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA.,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy B Spinner
- Division of Genomic Diagnostics and the Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela L Sankar
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Surabhi Mulchandani
- Division of Genomic Diagnostics and the Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Langer MM, Roche MI, Brewer NT, Berg JS, Khan CM, Leos C, Moore E, Brown M, Rini C. Development and Validation of a Genomic Knowledge Scale to Advance Informed Decision Making Research in Genomic Sequencing. MDM Policy Pract 2017; 2. [PMID: 29928697 PMCID: PMC6005662 DOI: 10.1177/2381468317692582] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background This study evaluated the psychometric properties of a new, comprehensive measure of knowledge about genomic sequencing, the University of North Carolina Genomic Knowledge Scale (UNC-GKS). Methods The UNC-GKS assesses knowledge in four domains thought to be critical for informed decision making about genomic sequencing. The scale was validated using classical test theory and item response theory in 286 adult patients and 132 parents of pediatric patients undergoing diagnostic whole exome sequencing (WES) in the NCGENES study. Results The UNC-GKS assessed a single underlying construct (genomic knowledge) with good internal reliability (Cronbach's alpha = 0.90). Scores were most informative (able to discriminate between individuals with different levels of genomic knowledge) at one standard deviation above the scale mean or lower, a range that included most participants. Convergent validity was supported by associations with health literacy and numeracy (rs=0.41-0.46). The scale functioned well across subgroups differing in sex, race/ethnicity, education, and English proficiency. Discussion Findings supported the promise of the UNC-GKS as a valid and reliable measure of genomic knowledge among people facing complex decisions about WES and comparable sequencing methods. It is neither disease- nor population-specific, and it functioned well across important subgroups, making it usable in diverse populations.
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Affiliation(s)
- Michelle M Langer
- American Institutes for Research, University of North Carolina, Chapel Hill, NC
| | - Myra I Roche
- Departments of Pediatrics and Genetics, University of North Carolina, Chapel Hill, NC.,Center for Genomics and Society, University of North Carolina, Chapel Hill, NC
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jonathan S Berg
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Cristina Leos
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | - Elizabeth Moore
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | - Michelle Brown
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Christine Rini
- Center for Genomics and Society, University of North Carolina, Chapel Hill, NC.,Department of Health Behavior, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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