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Kabeya V, Puthussery S, Furmanski A. Barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). J Genet Couns 2024; 33:425-444. [PMID: 37403830 DOI: 10.1002/jgc4.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/22/2023] [Accepted: 05/28/2023] [Indexed: 07/06/2023]
Abstract
Evidence suggests that although Black African women have the lowest incidence of breast and ovarian cancer, they have the highest mortality rate and low rates of uptake for cancer screening services for these conditions in the United Kingdom (UK). This study aimed to explore the perceived barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). We conducted a qualitative study that included one face-to-face and five telephone focus group discussions. Consistent with the health belief model, a focus group discussion guide was developed. A total of 24 participants, aged 23-57 who self-identified as Black African women and who were English speakers residing in Luton, took part in the focus group discussions. Purposive and snowballing sampling were used to recruit the participants for this study. The focus group discussions were recorded, transcribed per verbatim, coded and analyzed using an inductive thematic analysis approach, and the findings were classified. Nine themes emerged from the narratives obtained including six barriers and three facilitators. Barriers to genetic testing included (1) Cost and affordability, (2) Lack of knowledge, awareness, and family health history knowledge, (3) Language barrier, immigration, and distrust in western healthcare services, (4) Fear, (5) Cultural, religious, and intergenerational views and perceptions, and (6) Eligibility for genetic testing for the BRCA1/2 pathogenic variants and a lack of referral to specialist genetic clinics. Facilitators to genetic testing included (7) Availability of tests cost-free under the National Health Service (NHS) (8) Family members' health and (9) Awareness and education on genetic testing. The barriers and facilitators identified could enable policy makers and healthcare services alike to gain a better understanding of the factors influencing Black African women's decision-making process toward genetic testing. Ultimately, this work can inform interventions aiming to increase the uptake of genetic testing among this group.
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Affiliation(s)
- Valencia Kabeya
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Anna Furmanski
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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2
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White S, Turbitt E, Rogers K, Tucker K, McEwen A, Best M, Phillips JL, Jacobs C. A survey of genetic and palliative care health professionals' views of integrating genetics into palliative care. Eur J Hum Genet 2024; 32:109-116. [PMID: 37344570 PMCID: PMC10772073 DOI: 10.1038/s41431-023-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/14/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Genetic counselling and testing have utility for people with palliative care needs and their families. However, genetic and palliative care health professionals have described difficulties initiating palliative-genetic discussions. Between March and July 2022, we received n = 73 surveys (6% response rate) from genetic and palliative care health professionals in Australia and New Zealand that assessed and compared barriers and facilitators. The main perceived barrier to both groups was palliative care health professionals' lack of genetic knowledge (44%). Most palliative care health professionals were 'not at all confident' performing several activities, including discussing DNA banking (52%) and knowing their legal responsibilities when sharing genetic information (58%). The most frequently selected facilitator for genetic health professionals was fostering close relationships with palliative care health professionals (52%), while palliative care health professionals indicated a genetic referral template (51%) would be of assistance. Almost all participants agreed genetic discussions do not undermine the central ethos of palliative care (87%). Fewer palliative care health professionals considered themselves well situated to have genetic discussions with a palliative patient's family compared to genetic health professionals (p = 0.014). Our results suggest that genetic and palliative care health professionals support integrating genetics into palliative care, although refinement of the palliative care health professionals' role in this process is required. We have identified intervention targets to overcome barriers related to knowledge and confidence, which ought to be integrated into future interventions designed to support health professionals deliver the benefits of genetic information to people with palliative care needs and their families.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, Division of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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White S, Turbitt E, Phillips JL, Jacobs C. Approaching discussions about genetics with palliative patients and their families: a qualitative exploration with genetic health professionals. Eur J Hum Genet 2022:10.1038/s41431-022-01179-7. [PMID: 36064787 PMCID: PMC9441822 DOI: 10.1038/s41431-022-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
Genetic information can provide clinical benefits to families of palliative patients. However, integration of genetics into mainstream medicine has not focused on palliative populations. We explored the views and experiences of genetic health professionals in addressing genetics with palliative patients, and their families. We conducted an interpretive descriptive qualitative study with genetic counsellors and clinical geneticists using interviews and focus groups. Findings were generated using reflexive thematic analysis. Three themes were identified: (1) Focusing on the benefit to the family, (2) The discomfort of addressing genetics near end-of-life and (3) "It's always on the back-burner": Challenges to getting genetics on the palliative care agenda. Participants discussed the familial benefit of genetics in palliative care alongside the challenges when patients are near end-of-life. They perceived genetics as low priority for palliative care due to misunderstandings related to the value of genetic information. Acknowledging the challenges in the palliative care context, genetic health professionals want improved service leadership and awareness of the familial benefits of palliative genetic testing. Strong leadership to support genetic health professionals in addressing these barriers is needed for the benefits of genetic information to be realised.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Buras AL, Barkhurst M, Rutherford TJ, Anderson ML, English DP. The Intersection of Palliative Care and Genetic Counseling in Cancer Care: A Case Discussion. J Palliat Med 2021; 25:167-171. [PMID: 34851746 DOI: 10.1089/jpm.2021.0169] [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: 11/13/2022] Open
Abstract
Up to 10% of cancers have a strong hereditary component. The diagnosis of a hereditary cancer may alter treatment recommendations for the patient. However, the optimal timing and best practices for integrating genetic counseling and testing into the care of women diagnosed with cancer remains unclear. In this study, we demonstrate the potential benefits of discussing genetic testing and counseling in the context of palliative care through two cases. Incorporating referrals for genetic testing into the palliative care context is important. This provides an opportunity to perform previously missed genetic testing. It is also a chance for the patient to leave a legacy while also potentially allowing for alternate targeted treatment possibilities that may be well tolerated and provide a better quality of life for the patients themselves. The benefits of referral to palliative care by the genetics team includes assisting patients with the management of not only physical but also psychological symptoms as well as conducting advanced care planning in patients and families with hereditary mutations.
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Affiliation(s)
- Andrea L Buras
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Meghan Barkhurst
- Department of Palliative Care, Chesapeake Regional Medical Center, Chesapeake, Virginia, USA
| | - Thomas J Rutherford
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Matthew L Anderson
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Diana P English
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA.,Department of Palliative Medicine, University of South Florida, Tampa, Florida, USA
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Views and experiences of palliative care clinicians in addressing genetics with individuals and families: a qualitative study. Support Care Cancer 2021; 30:1615-1624. [PMID: 34549349 DOI: 10.1007/s00520-021-06569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A proportion of people with palliative care needs unknowingly have a genetic predisposition to their disease, placing relatives at increased risk. As end-of-life nears, the opportunity to address genetics for the benefit of their family narrows. Clinicians face numerous barriers addressing genetic issues, but there is limited evidence from the palliative care clinician perspective. Our aims are to (1) explore the views and experiences of palliative care clinicians in addressing genetics with patients and their families and (2) generate suggested strategies that support integration of genetics into palliative care. METHODS An interpretive descriptive qualitative study using semi-structured interviews with palliative care doctors and nurses (N = 14). RESULTS Three themes were identified: (1) Harms and benefits of raising genetics: a delicate balancing act, (2) Navigating genetic responsibility within the scope of palliative care and (3) Overcoming practice barriers: a multipronged approach. Participants described balancing the benefits of addressing genetics in palliative care against potential harms. Responsibility to address genetic issues depends on perceptions of relevance and the scope of palliative care. Suggestions to overcome practice barriers included building genetic-palliative care relationships and multi-layered genetics education, developing clinical resources and increasing organisational support. CONCLUSIONS Integrating aspects of genetics is feasible, but must be balanced against potential harms and benefits. Palliative care clinicians were uncertain about their responsibility to navigate these complex issues to address genetics. There are opportunities to overcome barriers and tailor support to ensure people nearing end-of-life have a chance to address genetic issues for the benefit of their families.
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Issues related to family history of cancer at the end of life: a palliative care providers' survey. Fam Cancer 2019; 17:303-307. [PMID: 28674754 DOI: 10.1007/s10689-017-0021-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Addressing the concerns of end-of-life patients or their relatives about their family history of cancer could benefit patients and family members. Little is known about how palliative care providers respond to these concerns. The purpose of this pilot study was to assess palliative care providers' knowledge about familial and hereditary cancers and explore their exposure to patients' and relatives' concerns about their family history of cancer, and their self-perceived ability to deal with such concerns. A cross-sectional survey was conducted in the Quebec City (Canada) catchment area among palliative care professionals. Fifty-eight palliative care professionals working in hospice, home care and hospital-based palliative care units completed the questionnaire. All physicians and 63% of nurses occasionally addressed concerns of patients and relatives about their family history of cancer, but they reported a low confidence level in responding to such concerns. They also showed knowledge gaps in defining features of a significant family history of cancer, and most (78%) would welcome specific training on the matter. Our findings highlight the relevance of offering education and training opportunities about familial cancers and associated risks to palliative care providers. The needs and concerns of end-of-life patients and their families need to be explored to ensure palliative care providers can adequately assist patients and their relatives about their family history of cancer. Ethical implications should be considered.
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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Mainstreaming genetics in palliative care: barriers and suggestions for clinical genetic services. J Community Genet 2017; 9:243-256. [PMID: 29159708 DOI: 10.1007/s12687-017-0345-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/07/2017] [Indexed: 01/20/2023] Open
Abstract
Palliative healthcare professionals (PHCPs) frequently do not refer their eligible patients for genetic testing. After the death of the affected individual, clinically relevant information for family members is lost. In previous research, PHCPs stated that the end-of-life setting is not appropriate to discuss genetic issues. It is unclear if this has changed due to increasing awareness of genetics in the media and efforts to mainstream genetic testing. Semi-structured interviews of PHCPs were analysed by thematic analysis. Seven PHCPs (four nurses, two consultants, and one clinical psychologist) were interviewed. Participants reported feeling unfamiliar with the role of clinical genetics services, and did not feel confident in addressing genetic issues with their patients. A lack of scientific knowledge and unawareness of existing infrastructure to support their patients were cited. Many stated that palliative patients are interested in exploring a potential hereditary component to their disease, and acknowledged the potential for psychological benefit for their patients and their families. Most stated that addressing genetics fits within their skill set, but expressed concern about issues of consent, logistical difficulties, and ethical dilemmas. These perceptions differ considerably from those reported in existing literature. Importantly, each participant stated that the potential benefits of addressing genetic issues outweighed the potential for harm in most cases. These results suggest a need for clinical genetics staff to develop closer links with their local PHCPs and to provide education. Clinical psychologists may also be a helpful resource to address PHCPs' concerns.
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Mathew SS, Barwell J, Khan N, Lynch E, Parker M, Qureshi N. Inclusion of diverse populations in genomic research and health services: Genomix workshop report. J Community Genet 2017; 8:267-273. [PMID: 28755064 DOI: 10.1007/s12687-017-0317-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/29/2017] [Indexed: 01/09/2023] Open
Abstract
Clinical genetic services and genomic research are rapidly developing but, historically, those with the greatest need are the least to benefit from these advances. This encompasses low-income communities, including those from ethnic minority and indigenous backgrounds. The "Genomix" workshop at the European Society of Human Genetics (ESHG) 2016 conference offered the opportunity to consider possible solutions for these disparities from the experiences of researchers and genetic healthcare practitioners working with underserved communities in the USA, UK and Australia. Evident from the workshop and corresponding literature is that a multi-faceted approach to engaging communities is essential. This needs to be complemented by redesigning healthcare systems that improves access and raises awareness of the needs of these communities. At a more strategic level, institutions involved in funding research, commissioning and redesigning genetic health services also need to be adequately represented by underserved populations with intrinsic mechanisms to disseminate good practice and monitor participation. Further, as genomic medicine is mainstreamed, educational programmes developed for clinicians should incorporate approaches to alleviate disparities in accessing genetic services and improving study participation.
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Affiliation(s)
- Savio S Mathew
- University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Julian Barwell
- Clinical Genetics Department, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Nasaim Khan
- Genomic medicine, St. Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Ella Lynch
- Melbourne Genomics Health Alliance, c/o WEHI, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK.
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Adams LS, Miller JL, Grady PA. The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions. J Palliat Med 2016; 19:698-705. [PMID: 27249541 DOI: 10.1089/jpm.2015.0464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rare diseases are often life-limiting conditions, the majority of which require constant caregiving needs. The realization of a spectrum of palliative care throughout the trajectory of rare diseases could ensure individualized and caregiver-focused approaches to the care of patients and families. In June 2015, the National Institute of Nursing Research (NINR), the lead institute at the National Institutes of Health for end-of-life research, in conjunction with the National Center for Advancing Translational Sciences, Office of Rare Diseases Research (ORDR) held an interdisciplinary workshop on the unique challenges of caregiving and palliative care in adult and pediatric rare diseases. The panel identified gaps in current knowledge, and afforded suggestions for research opportunities in palliative care science to improve the care of individuals with serious, advanced, rare diseases and their caregivers. This meeting provided an in-depth opportunity to incorporate new concepts into palliative and end-of-life care for individuals with a range of rare diseases and their caregivers. This report presents a summary of the workshop.
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Affiliation(s)
- Lynn S Adams
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Jeri L Miller
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Patricia A Grady
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
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