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Mintoff D, Booker B, Debono S, Farrugia M, Pace NP. Attitudes towards disclosure of familial genetic risk in a Mediterranean island population - A survey of the Maltese population. Eur J Med Genet 2024; 71:104961. [PMID: 39053721 DOI: 10.1016/j.ejmg.2024.104961] [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: 03/26/2024] [Revised: 07/09/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
Germline genetic testing has implications that extend beyond the individual patient to relatives, particularly for high-penetrance variants implicated in hereditary cancer or neurodegenerative syndromes. Many countries encourage patient-led communication to inform at-risk relatives, although the efficacy and uptake of this approach varies. Alternative scenarios envisage direct contact mediated by clinicians. The familial disclosure of sensitive genetic information is also determined by complex socio-ethnic factors. To date, no study has explored whether relatives would want to be informed of familial genetic risk and their preferences on different methods of communication in Malta. We thus used a published instrument that utilizes hypothetical scenario methodology to survey the attitudes of the Maltese population (n = 334) to receiving genetic information from family members. Two vignettes on Huntington's disease and colorectal cancer were presented. We also explored preferences towards the communication of genetic risk, confidentiality, and disclosure policies. Our preliminary results show that most respondents want to be informed of their increased risk by a family member or a clinician and would opt to receive confirmatory genetic testing. Most respondents preferred being informed of genetic risk by a close relative, but in the case of non-disclosure would want to be informed by a clinician. Most respondents expressed preference in favour of the introduction of registries, legislative change and sharing of contact details to address cases of nondisclosure. Our findings contribute further to evidence that supports, in selected hypothetical scenarios, an envisioned change in disclosure of genetic data policy by the public that is different from current practice to date.
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Affiliation(s)
- Dillon Mintoff
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Bettina Booker
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Shannon Debono
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Matthias Farrugia
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Nikolai Paul Pace
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta.
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2
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Binion S, Sorgen LJ, Peshkin BN, Valdimarsdottir H, Isaacs C, Nusbaum R, Graves KD, DeMarco T, Wood M, McKinnon W, Garber J, McCormick S, Ladd MK, Schwartz MD. Telephone versus in-person genetic counseling for hereditary cancer risk: Patient predictors of differential outcomes. J Telemed Telecare 2024; 30:334-343. [PMID: 34779303 PMCID: PMC9902210 DOI: 10.1177/1357633x211052220] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE Telegenetics has become the predominant mode of cancer genetic counseling during the COVID-19 pandemic. We sought to identify potential patient-level contraindicators for telegenetic genetic counseling. METHODS We analyzed post-counseling (pre-result disclosure) follow-up data from a randomized noninferiority trial of a telephone genetic counseling versus usual care genetic counseling. Among 669 randomized participants, 600 completed pre-test counseling and 568 completed a 2-week follow-up assessment before receiving test results. In this analysis, we focused on genetic counseling outcomes (knowledge, decisional conflict, and distress). In multivariate models controlling for bivariate predictors of these outcomes, we tested our a priori hypotheses that pre-counseling numeracy, perceived stress, and race/ethnicity would moderate the outcomes of telephone genetic counseling versus usual care. RESULTS Only numeracy significantly moderated associations between mode of genetic counseling and outcomes. Higher numeracy was associated with higher post-counseling knowledge following telephone genetic counseling (p < 0.001), but not usual care (p = 0.450). Higher numeracy was also associated with lower distress following telephone genetic counseling (p = 0.009) but not usual care (p = 0.16). Neither perceived stress nor race/ethnicity exhibited differential impacts on telephone genetic counseling versus usual care (ps > 0.20). CONCLUSION Although high numeracy was associated with higher levels of knowledge following telegenetic counseling, we did not identify any clinically significant patient-level contraindicators for telegenetic counseling. These results lend further confidence to the broad use of telegenetics.
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Affiliation(s)
- Savannah Binion
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Lia J. Sorgen
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Beth N. Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Heiddis Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Rachel Nusbaum
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: University of Maryland, School of Medicine, Baltimore, MD
| | - Kristi D. Graves
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Tiffani DeMarco
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA
| | - Marie Wood
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Wendy McKinnon
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
| | - Shelley McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mary K. Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Marc D. Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
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3
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Swisher EM, Rayes N, Bowen D, Peterson CB, Norquist BM, Coffin T, Gavin K, Polinsky D, Crase J, Bakkum-Gamez JN, Blank SV, Munsell MF, Nebgen D, Fleming GF, Olopade OI, Law S, Zhou A, Levine DA, D'Andrea A, Lu KH. Remotely Delivered Cancer Genetic Testing in the Making Genetic Testing Accessible (MAGENTA) Trial: A Randomized Clinical Trial. JAMA Oncol 2023; 9:1547-1555. [PMID: 37707822 PMCID: PMC10502696 DOI: 10.1001/jamaoncol.2023.3748] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/29/2023] [Indexed: 09/15/2023]
Abstract
Importance Requiring personalized genetic counseling may introduce barriers to cancer risk assessment, but it is unknown whether omitting counseling could increase distress. Objective To assess whether omitting pretest and/or posttest genetic counseling would increase distress during remote testing. Design, Setting, and Participants Making Genetic Testing Accessible (MAGENTA) was a 4-arm, randomized noninferiority trial testing the effects of individualized pretest and/or posttest genetic counseling on participant distress 3 and 12 months posttest. Participants were recruited via social and traditional media, and enrollment occurred between April 27, 2017, and September 29, 2020. Participants were women aged 30 years or older, English-speaking, US residents, and had access to the internet and a health care professional. Previous cancer genetic testing or counseling was exclusionary. In the family history cohort, participants had a personal or family history of breast or ovarian cancer. In the familial pathogenic variant (PV) cohort, participants reported 1 biological relative with a PV in an actionable cancer susceptibility gene. Data analysis was performed between December 13, 2020, and May 31, 2023. Intervention Participants completed baseline questionnaires, watched an educational video, and were randomized to 1 of 4 arms: the control arm with pretest and/or posttest genetic counseling, or 1 of 3 study arms without pretest and posttest counseling. Genetic counseling was provided by phone appointments and testing was done using home-delivered saliva kits. Main Outcomes and Measures The primary outcome was participant distress measured by the Impact of Event Scale 3 months after receiving the results. Secondary outcomes included completion of testing, anxiety, depression, and decisional regret. Results A total of 3839 women (median age, 44 years [range 22-91 years]), most of whom were non-Hispanic White and college educated, were randomized, 3125 in the family history and 714 in the familial PV cohorts. In the primary analysis in the family history cohort, all experimental arms were noninferior for distress at 3 months. There were no statistically significant differences in anxiety, depression, or decisional regret at 3 months. The highest completion rates were seen in the 2 arms without pretest counseling. Conclusions and Relevance In the MAGENTA clinical trial, omitting individualized pretest counseling for all participants and posttest counseling for those without PV during remote genetic testing was not inferior with regard to posttest distress, providing an alternative care model for genetic risk assessment. Trial Registration ClinicalTrials.gov Identifier: NCT02993068.
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Affiliation(s)
| | - Nadine Rayes
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
| | - Deborah Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Christine B Peterson
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Barbara M Norquist
- Department of Obstetrics & Gynecology, University of Washington, Seattle
| | - Tara Coffin
- Department of Bioethics and Humanities, University of Washington, Seattle
| | | | | | - Jamie Crase
- Department of Obstetrics & Gynecology, University of Washington, Seattle
| | | | - Stephanie V Blank
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark F Munsell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Denise Nebgen
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
| | - Gini F Fleming
- Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
| | | | | | | | - Douglas A Levine
- Perlmutter Cancer Center, NYU Langone Health, New York, New York
- Now with Merck Research Laboratories, Rahway, New Jersey
| | | | - Karen H Lu
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
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Rahma AT, Ali BR, Patrinos GP, Ahmed LA, Elbarazi I, Abdullahi AS, Elsheik M, Abbas M, Afandi F, Alnaqbi A, Al Maskari F. Knowledge, attitudes, and perceptions of the multi-ethnic population of the United Arab Emirates on genomic medicine and genetic testing. Hum Genomics 2023; 17:63. [PMID: 37454085 PMCID: PMC10349494 DOI: 10.1186/s40246-023-00509-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The adoption and implementation of genomic medicine and pharmacogenomics (PGx) in healthcare systems have been very slow and limited worldwide. Major barriers to knowledge translation into clinical practice lie in the level of literacy of the public of genetics and genomics. The aim of this study was to assess the knowledge, attitudes, and perceptions of the United Arab Emirates (UAE) multi-ethnic communities toward genomic medicine and genetic testing. METHOD A cross-sectional study using validated questionnaires was distributed to the participants. Descriptive statistics were performed, and multivariable logistic regression models were used to identify factors associated with knowledge of genomics. RESULTS 757 individuals completed the survey. Only 7% of the participants had a good knowledge level in genetics and genomics (95% CI 5.3-9.0%). However, 76.9% of the participants were willing to take a genetic test if their relatives had a genetic disease. In addition, the majority indicated that they would disclose their genetic test results to their spouses (61.5%) and siblings (53.4%). CONCLUSIONS This study sets the stage for the stakeholders to plan health promotion and educational campaigns to improve the genomic literacy of the community of the UAE as part of their efforts for implementing precision and personalized medicine in the country.
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Affiliation(s)
- Azhar T Rahma
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - George P Patrinos
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, UAE
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, UAE
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Aminu S Abdullahi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Mahanna Elsheik
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maram Abbas
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Department of Clinical Pharmacy and Therapeutics, Dubai Pharmacy College for Girls, Dubai, UAE
| | - Farah Afandi
- USF Biotechnology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Biochemistry, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Aisha Alnaqbi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Fatma Al Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE.
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, UAE.
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5
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Blondeaux E, Lambertini M, Buzzatti G, Bruzzone C, Baraga M, Pisani R, Del Mastro L, Pronzato P, Varesco L, Bonelli L. Experience with a nurse-driven genetic counseling pathway of Italian women with uninformative BRCA test result. J Genet Couns 2023; 32:140-152. [PMID: 36036895 PMCID: PMC10087002 DOI: 10.1002/jgc4.1630] [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: 09/17/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
Several models of genetic counseling have been proposed to tackle the increasing volume of individuals requiring access to BRCA testing. Few data are available on patient experience and retention of information with nurse-driven genetic counseling. We evaluated the experience and retention of information in women with an uninformative BRCA test result and who were not considered at high risk due to their personal/family history of cancer who underwent geneticist-supervised nurse-driven genetic counseling and who received their test result by phone. Women who received an uninformative BRCA test result between May 2017 and September 2019 were administered a questionnaire exploring experience with genetic counseling and retention of information provided. Of 366 eligible women, 299 (273 breast cancer patients and 26 women without breast cancer) completed the interview. Overall, 280 women (93.6%) positively valued their experience with genetic counseling and 287 (96.0%) considered it helpful with 57.5% of them feeling reassured for themselves and their family. Information on the clinical implications of the test result was correctly retained and women acted accordingly. Overall, 252 women (87.8%) accurately reported their test result as normal/negative. Only 67 (22.4%) recognized that despite a normal BRCA test result, a low probability of a hereditary syndrome remains. Most women showed a poor ability to estimate cancer risk in BRCA mutation carriers and in the general population. Geneticist-supervised nurse-driven genetic counseling process for women with uninformative BRCA test result is associated with a positive patient experience and an adequate retention of information concerning the management of their personal and familial cancer risk. The design and implementation of nurse-driven genetic counseling models may contribute to efficient and timely access to BRCA genetic testing.
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Affiliation(s)
- Eva Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.,Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Buzzatti
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carla Bruzzone
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marina Baraga
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberta Pisani
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Paolo Pronzato
- Department of Medical Oncology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Liliana Varesco
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luigina Bonelli
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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6
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Dantas MAA, Da Silva JD, Tkachenko N, Paneque M. Telehealth in genetic counselling consultations: the impact of COVID-19 in a Portuguese genetic healthcare service. J Community Genet 2023; 14:91-100. [PMID: 36414926 PMCID: PMC9685011 DOI: 10.1007/s12687-022-00618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
The already increasing use of telemedicine in the last few years has risen significantly after the onset of the COVID-19 pandemic. With a fast implementation, it is important to understand the experience of genetic counselling patients using telehealth. To this end, we developed a study to understand the impact of the pandemic on genetics consultations, using a mixed-method approach through a questionnaire to collect the patients' opinions. The largest group included in the study was 26-45 years old (65%), and 33.6% had completed year 12 of secondary education. Due to the impact of the pandemic, we observed an increase of 84.5% in teleconsultations. The participants' satisfaction was quite significant, 67.3% felt comfortable discussing personal and family health, 53.6% were well-enlightened, and 59.1% did not find it difficult to build a doctor-patient relationship. However, 64.5% of our participants indicated using the service only for subsequent consultations but supported the idea of continuing with telemedicine in the future. Undoubtedly, this service is essential for better quality and healthcare support. The professionals involved must be increasingly trained to provide adequate genetic counselling and comfort to the patient. Training automatically influences the improvement of the service regarding the barriers encountered and consequently provides a better experience and satisfaction to the patient and their families.
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Affiliation(s)
- Mayla A. A. Dantas
- ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Diogo Da Silva
- CGM - Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal ,ICVS - Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal ,ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nataliya Tkachenko
- CGM - Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Milena Paneque
- ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal ,CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação EM Saúde, Universidade do Porto, Porto, Portugal
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7
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Costanzo S, De Summa S, Maurmo L, Digennaro M, Patruno M, Paradiso A. Remote vs in-person BRCA1/2 non-carriers test disclosure: patients' choice during Covid-19 pandemic restriction. Fam Cancer 2023; 22:43-48. [PMID: 35867288 PMCID: PMC9304797 DOI: 10.1007/s10689-022-00307-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/09/2022] [Indexed: 01/17/2023]
Abstract
During Covid-19 pandemic most hospitals have restricted in-person delivery of non-essential healthcare services, including genetic testing delivery, to slow the spread of the virus. Our Onco-Genetic Service also faced this challenging period and had to re-organize its clinical practice with the use of tele-health. Aim of the present paper is to understand whether and how Covid-19-related changes in medical practice influenced patients' satisfaction about the health service provided. 125 BRCA1/2 non carriers (109/125, 87.2% female and 16/125, 12.8% male) in Istituto Tumori "Giovanni Paolo II" of Bari were enrolled. All participants were asked to choose whether they prefer in-person or remote post-test counselling session. Basing on patients' choice, two groups of subjects were composed. One week after the post-test counselling session, participants were phone called and asked to complete: a socio-demographic form, a brief structured interview about their Covid-19 related worries and their satisfaction with the health service provided, Hospital Anxiety and Depression Scale and Fear of Covid-19 scale. Qualitative information about patients' choice were also collected. No significant difference about patients' satisfaction with the health service provided emerged between groups. Patients who preferred remote post-test counselling had higher anxiety, worries and fear-of Covid-19 than the others. All remote-counselling subjects preferred tele-genetics because of Covid-19 security, would choose it again and would recommend it to others. Cancer tele-genetics offers good guarantees of comfort and efficacy, but patients' choices are related to personal and psychological variables. The use of tele-genetics has to be a patient's choice.
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Affiliation(s)
- Silvia Costanzo
- Experimental Oncology and Biobanking Unit, Heredo-Familiar Cancer Clinic, IRCCS - Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Simona De Summa
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS - Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Leonarda Maurmo
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS - Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Maria Digennaro
- Experimental Oncology and Biobanking Unit, Heredo-Familiar Cancer Clinic, IRCCS - Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Margherita Patruno
- Experimental Oncology and Biobanking Unit, Heredo-Familiar Cancer Clinic, IRCCS - Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Angelo Paradiso
- Scientific Direction, IRCCS - Istituto Tumori “Giovanni Paolo II”, Bari, Italy
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8
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Wynn J, Milo Rasouly H, Vasquez-Loarte T, Saami AM, Weiss R, Ziniel SI, Appelbaum PS, Wright Clayton E, Christensen KD, Fasel D, Green RC, Hain HS, Harr M, Hoell C, Kullo IJ, Leppig KA, Myers MF, Pacyna JE, Perez EF, Prows CA, Kulchak Rahm A, Campbell-Salome G, Sharp RR, Smith ME, Wiesner GL, Williams JL, Blout Zawatsky CL, Gharavi AG, Chung WK, Holm IA. Do research participants share genomic screening results with family members? J Genet Couns 2021; 31:447-458. [PMID: 34665896 DOI: 10.1002/jgc4.1511] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 01/25/2023]
Abstract
The public health impact of genomic screening can be enhanced by cascade testing. However, cascade testing depends on communication of results to family members. While the barriers and facilitators of family communication have been researched following clinical genetic testing, the factors impacting the dissemination of genomic screening results are unknown. Using the pragmatic Electronic Medical Records and Genomics Network-3 (eMERGE-3) study, we explored the reported sharing practices of participants who underwent genomic screening across the United States. Six eMERGE-3 sites returned genomic screening results for mostly dominant medically actionable disorders and surveyed adult participants regarding communication of results with first-degree relatives. Across the sites, 279 participants completed a 1-month and/or 6-month post-results survey. By 6 months, only 34% of the 156 respondents shared their results with all first-degree relatives and 4% did not share with any. Over a third (39%) first-degree relatives were not notified of the results. Half (53%) of participants who received their results from a genetics provider shared them with all first-degree relatives compared with 11% of participants who received their results from a non-genetics provider. The most frequent reasons for sharing were a feeling of obligation (72%) and that the information could help family members make medical decisions (72%). The most common reasons indicated for not sharing were that the family members were too young (38%), or they were not in contact (25%) or not close to them (25%). These data indicate that the professional returning the results may impact sharing patterns, suggesting that there is a need to continue to educate healthcare providers regarding approaches to facilitate sharing of genetic results within families. Finally, these data suggest that interventions to increase sharing may be universally effective regardless of the origin of the genetic result.
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Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Hila Milo Rasouly
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Tania Vasquez-Loarte
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Akilan M Saami
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robyn Weiss
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sonja I Ziniel
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavior Genetics, Columbia University Irving Medical Center, New York, NY, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kurt D Christensen
- Department of Population Medicine, Precision Medicine Translational Research (PROMoTeR) Center, Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - David Fasel
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heather S Hain
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Margaret Harr
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christin Hoell
- Center for Genetic Medicine, Northwestern University, Chicago, IL, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathleen A Leppig
- Genetic Services and Kaiser Permanente Washington Health Research Institute, Kaiser Permanente of Washington, Seattle, WA, USA
| | - Melanie F Myers
- Divisions of Human Genetics and Patient Services, Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joel E Pacyna
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA
| | - Emma F Perez
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University, Chicago, IL, USA
| | - Georgia L Wiesner
- Division of Genetic Medicine, Department of Medicine, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Ali G Gharavi
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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9
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Patient-Reported Outcomes following Genetic Testing for Familial Hypercholesterolemia, Breast and Ovarian Cancer Syndrome, and Lynch Syndrome: A Systematic Review. J Pers Med 2021; 11:jpm11090850. [PMID: 34575627 PMCID: PMC8467628 DOI: 10.3390/jpm11090850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Patient-reported outcomes (PROs) and PRO measures (PROMs) are real-world evidence that can help capture patient experiences and perspectives regarding a clinical intervention such as genetic testing. Objective: To identify and capture methods and qualitative PRO themes among studies reporting PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Methods: A systematic review was conducted via PubMed/MEDLINE, EMBASE, and Yale University’s TRIP Medical Databases on articles published by April 2021. Results: We identified 24 studies published between 1996 and 2021 representing 4279 participants that reported PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Studies collected and reported PROs from validated PROM instruments (n = 12; 50%), validated surveys (n = 7; 26%), and interviews (n = 10; 42%). PRO themes ranged across all collection methods (e.g., psychological, knowledge, coping and satisfaction, concern about stigma/discrimination, etc.). Conclusions: Important gaps identified include (1) most studies (n = 18; 75%) reported PROs following genetic testing for breast and ovarian cancer, and (2) populations reporting PROs overall were largely of White/Caucasian/Northern European/Anglo-Saxon descent. We offer recommendations and describe real-world implications for the field moving forward.
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10
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Dratch L, Paul RA, Baldwin A, Brzozowski M, Gonzalez-Alegre P, Tropea TF, Raper A, Bardakjian T. Transitioning to telegenetics in the COVID-19 era: Patient satisfaction with remote genetic counseling in adult neurology. J Genet Couns 2021; 30:974-983. [PMID: 34265143 PMCID: PMC8427091 DOI: 10.1002/jgc4.1470] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/13/2023]
Abstract
The COVID-19 pandemic rapidly changed genetic counseling services across the United States. At the University of Pennsylvania (UPenn), a large academic hospital in an urban setting, nearly all genetic counseling (GC) visits for adult-onset disorders within the Department of Neurology were conducted via secure videoconferencing (telegenetics) or telephone between March and December 2020. Although telemedicine services have been steadily emerging, many clinical programs, including the neurogenetics program at UPenn, had not built infrastructure or widely utilized these services prior to the pandemic. Thus, little is known about patient attitudes toward receiving clinical GC services remotely. From May 18 to October 18, 2020, all individuals seen remotely for GC in adult neurology via telephone or telegenetics were surveyed about their satisfaction with telehealth GC (N = 142), with a response rate of 42% (N = 60/142). Telephone and telegenetics services were referred to as 'telehealth' in the surveys to capture patient perspectives on all remote GC services, though the majority (N = 49/60) of these visits were completed via telegenetics. Surveys included the modified telehealth usability questionnaire (MTUQ), genetic counseling satisfaction scale (GCSS), and novel questions about future telehealth use. Preliminary results suggest that patients were satisfied with receiving remote GC services in adult neurology, with most participants strongly agreeing to all items about satisfaction with telehealth. Just 2% of participants preferred only in-person visits in the future, but every participant was willing to consider using telehealth for future visits if their genetic counselor felt it was appropriate. Most participants preferred a hybrid model (73%), and some (25%) preferred only telehealth for future visits. Additionally, we found no differences in satisfaction with remote services based on visit type (initial vs. results disclosure) nor age. We conclude that remote GC is an acceptable method for the provision of services in adult neurology that is well-received by patients.
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Affiliation(s)
- Laynie Dratch
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Paul
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Baldwin
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Morgan Brzozowski
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Tropea
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Raper
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanya Bardakjian
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Cléophat JE, Dorval M, El Haffaf Z, Chiquette J, Collins S, Malo B, Fradet V, Joly Y, Nabi H. Whether, when, how, and how much? General public's and cancer patients' views about the disclosure of genomic secondary findings. BMC Med Genomics 2021; 14:167. [PMID: 34174888 PMCID: PMC8236159 DOI: 10.1186/s12920-021-01016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data on the modalities of disclosing genomic secondary findings (SFs) remain scarce. We explore cancer patients' and the general public's perspectives about disclosing genomic SFs and the modalities of such disclosure. METHODS Sixty-one cancer patients (n = 29) and members of the public (n = 32) participated in eight focus groups in Montreal and Quebec City, Canada. They were asked to provide their perspectives of five fictitious vignettes related to medically actionable and non-actionable SFs. Two researchers used a codification framework to conduct a thematic content analysis of the group discussion transcripts. RESULTS Cancer patients and members of the public were open to receive genomic SFs, considering their potential clinical and personal utility. They believed that the right to know or not and share or not such findings should remain the patient's decision. They thought that the disclosure of SFs should be made mainly in person by the prescribing clinician. Maintaining confidentiality when so requested and preventing genetic discrimination were considered essential. CONCLUSION Participants in this study welcomed the prospect of disclosing genomic SFs, as long as the right to choose to know or not to know is preserved. They called for the development of policies and practice guidelines that aim to protect genetic information confidentiality as well as the autonomy, physical and psychosocial wellbeing of patients and families.
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Affiliation(s)
- Jude Emmanuel Cléophat
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
- Research Center of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada
| | - Zaki El Haffaf
- Division of Genetics, Department of Medicine, Hospital Center of the University of Montreal, Montreal, QC, Canada
- Oncology Division, Research Center of the Hospital Center of the University of Montreal, Montreal, QC, Canada
| | - Jocelyne Chiquette
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Benjamin Malo
- Infectious and Immune Diseases Division, Research center of the Quebec City University Hospital, Quebec City, QC, Canada
| | - Vincent Fradet
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Yann Joly
- Center of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Hermann Nabi
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.
- Laval University Cancer Research Center, Quebec City, QC, Canada.
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
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12
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López-Fernández A, Villacampa G, Grau E, Salinas M, Darder E, Carrasco E, Torres-Esquius S, Iglesias S, Solanes A, Gadea N, Velasco A, Urgell G, Torres M, Tuset N, Brunet J, Corbella S, Balmaña J. Patients' and professionals' perspective of non-in-person visits in hereditary cancer: predictors and impact of the COVID-19 pandemic. Genet Med 2021; 23:1450-1457. [PMID: 33824504 PMCID: PMC8023774 DOI: 10.1038/s41436-021-01157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To identify predictors of patient acceptance of non-in-person cancer genetic visits before and after the COVID-19 pandemic and assess the preferences of health-care professionals. METHODS Prospective multicenter cohort study (N = 578, 1 February 2018-20 April 2019) and recontacted during the COVID-19 lockdown in April 2020. Health-care professionals participated in May 2020. Association of personality traits and clinical factors with acceptance was assessed with multivariate analysis. RESULTS Before COVID-19, videoconference was more accepted than telephone-based visits (28% vs. 16% pretest, 30% vs. 19% post-test). Predictors for telephone visits were age (pretest, odds ratio [OR] 10-year increment = 0.79; post-test OR 10Y = 0.78); disclosure of panel testing (OR = 0.60), positive results (OR = 0.52), low conscientiousness group (OR = 2.87), and post-test level of uncertainty (OR = 0.93). Predictors for videoconference were age (pretest, OR 10Y = 0.73; post-test, OR 10Y = 0.75), educational level (pretest: OR = 1.61), low neuroticism (pretest, OR = 1.72), and post-test level of uncertainty (OR = 0.96). Patients' reported acceptance for non-in-person visits after COVID-19 increased to 92% for the pretest and 85% for the post-test. Health-care professionals only preferred non-in-person visits for disclosure of negative results (83%). CONCLUSION These new delivery models need to recognize challenges associated with age and the psychological characteristics of the population and embrace health-care professionals' preferences.
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Affiliation(s)
- Adrià López-Fernández
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Elia Grau
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Mónica Salinas
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Silvia Iglesias
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Ares Solanes
- Hereditary Cancer Program, Germans Trias i Pujol Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Neus Gadea
- Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Angela Velasco
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Gisela Urgell
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Barcelona, Spain
| | - Maite Torres
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Tuset
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Sergi Corbella
- School of Psychology, Education and Sports Sciences. Ramon Llull University-Blanquerna, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. .,Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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13
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Pozzar RA, Hong F, Xiong N, Stopfer JE, Nayak MM, Underhill-Blazey M. Knowledge and psychosocial impact of genetic counseling and multigene panel testing among individuals with ovarian cancer. Fam Cancer 2021; 21:35-47. [PMID: 33751319 DOI: 10.1007/s10689-021-00240-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
In a sample of individuals with ovarian cancer, we aimed to (a) identify factors associated with the psychosocial impact of genetic counseling and multigene panel testing, (b) identify factors associated with cancer genetics knowledge, and (c) summarize patient-reported recommendations to improve the genetic counseling and multigene panel testing process. Eligible participants in this secondary analysis of quantitative and qualitative survey data were English-speaking adults with ovarian cancer. Psychosocial impact was assessed using the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire. Knowledge of cancer genetics was assessed using the KnowGene scale. Significant predictors of MICRA and KnowGene scores were identified using multiple regression. Open-ended survey item responses were analyzed using conventional content analysis. Eighty-seven participants met eligibility criteria. A positive genetic test result was associated with greater adverse psychosocial impact (B = 1.13, p = 0.002). Older age (B = - 0.07, p = 0.044) and being a member of a minority racial or ethnic group (B = - 3.075, p = 0.033) were associated with lower knowledge, while a personal history of at least one other type of cancer (B = 1.975, p = 0.015) was associated with higher knowledge. In open-ended item responses, participants wanted clinicians to assist with family communication, improve result disclosure, and enhance patient and family understanding of results. A subset of individuals with ovarian cancer who receive a positive genetic test result may be at risk for adverse psychosocial outcomes. Tailored cancer genetics education is necessary to promote the equitable uptake of targeted ovarian cancer treatment and risk-reducing therapies. Interventions to enhance patient-clinician communication in this setting are a research priority.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Jill E Stopfer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Manan M Nayak
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Meghan Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.,University of Rochester, 601 Elmwood Ave., Rochester, NY, 14642, USA
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14
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Bracke X, Roberts J, McVeigh TP. A systematic review and meta-analysis of telephone vs in-person genetic counseling in BRCA1/BRCA2 genetic testing. J Genet Couns 2020; 30:563-573. [PMID: 33131182 DOI: 10.1002/jgc4.1343] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/08/2022]
Abstract
Pathogenic variants in the BRCA1 and BRCA2 genes increase the risk of breast and ovarian cancer. Individuals with identified pathogenic variants in the BRCA1 or BRCA2 gene can benefit from cancer risk-reducing strategies. In the recent years, there has been an increase in the demand of genetic services. In light of the ongoing COVID19 pandemic, alternatives to face-to-face consultations have had to be considered and adopted, including telemedicine. Informed consent is necessary for genetic testing. Studies have suggested that increased levels of cancer-specific distress may impair the patient's ability to retain information, therefore, providing informed consent. This systematic review and meta-analysis aimed to answer if telephone genetic counseling for BRCA1 and BRCA2 genetic testing is non-inferior to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Databases of Medline, Embase, PsycINFO, CINAHL, SciELO, Web of Science, CENTRAL, ProQuest Dissertation & Theses Database, Clinicaltrials.gov, EU clinical trials register were accessed to identify any published or unpublished relevant literature. Random-effects models were used for the meta-analysis. Four studies were included in the qualitative synthesis of the results. Three studies were included in the quantitative synthesis of the results. Telephone genetic counseling was non-inferior compared to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Sensitivity analysis corroborated the main results. Telephone genetic counseling for BRCA1/BRCA2 genetic testing may be an alternative model of delivering genetic services in front of the increased demand/or when required by social context. However, the paucity of the evidence prevents from drawing strong conclusions regarding the generalizability of these results. Further research is needed to strengthen the conclusions.
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Affiliation(s)
- Xavier Bracke
- Institute of Continuing Education, University of Cambridge, Cambridge, UK.,Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jonathan Roberts
- Institute of Continuing Education, University of Cambridge, Cambridge, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK
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15
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Mahon SM. Considerations for the Telephone Disclosure of Genetic Test Results to Patients With Cancer. Clin J Oncol Nurs 2020; 24:8. [PMID: 31961845 DOI: 10.1188/20.cjon.8] [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] [Indexed: 11/17/2022]
Abstract
I would like to thank Cantril, Moore, and Yan (2019) for their informative article on patient preferences for the disclosure of a breast cancer diagnosis in the December issue of the Clinical Journal of Oncology Nursing. The findings of Cantril et al.'s (2019) study suggest that patients prefer in-person disclosure. Additional patient priorities included knowing the results of tests quickly, having those results disclosed by an expert with a sensitive touch, and having a clear understanding of the next steps in the treatment plan.
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16
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McCarthy AM. Persistent Underutilization of BRCA1/2 Testing Suggest the Need for New Approaches to Genetic Testing Delivery. J Natl Cancer Inst 2020; 111:751-753. [PMID: 30753664 DOI: 10.1093/jnci/djz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/07/2023] Open
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17
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Yue JK, Cnossen MC, Winkler EA, Deng H, Phelps RRL, Coss NA, Sharma S, Robinson CK, Suen CG, Vassar MJ, Schnyer DM, Puccio AM, Gardner RC, Yuh EL, Mukherjee P, Valadka AB, Okonkwo DO, Lingsma HF, Manley GT. Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study. Front Neurol 2019; 10:343. [PMID: 31024436 PMCID: PMC6465546 DOI: 10.3389/fneur.2019.00343] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Over 70% of traumatic brain injuries (TBI) are classified as mild (mTBI), which present heterogeneously. Associations between pre-injury comorbidities and outcomes are not well-understood, and understanding their status as risk factors may improve mTBI management and prognostication. Methods: mTBI subjects (GCS 13-15) from TRACK-TBI Pilot completing 3- and 6-month functional [Glasgow Outcome Scale-Extended (GOSE)] and post-concussive outcomes [Acute Concussion Evaluation (ACE) physical/cognitive/sleep/emotional subdomains] were extracted. Pre-injury comorbidities >10% incidence were included in regressions for functional disability (GOSE ≤ 6) and post-concussive symptoms by subdomain. Odds ratios (OR) and mean differences (B) were reported. Significance was assessed at p < 0.0083 (Bonferroni correction). Results: In 260 subjects sustaining blunt mTBI, mean age was 44.0-years and 70.4% were male. Baseline comorbidities >10% incidence included psychiatric-30.0%, cardiac (hypertension)-23.8%, cardiac (structural/valvular/ischemic)-20.4%, gastrointestinal-15.8%, pulmonary-15.0%, and headache/migraine-11.5%. At 3- and 6-months separately, 30.8% had GOSE ≤ 6. At 3-months, psychiatric (GOSE ≤ 6: OR = 2.75, 95% CI [1.44-5.27]; ACE-physical: B = 1.06 [0.38-1.73]; ACE-cognitive: B = 0.72 [0.26-1.17]; ACE-sleep: B = 0.46 [0.17-0.75]; ACE-emotional: B = 0.64 [0.25-1.03]), headache/migraine (GOSE ≤ 6: OR = 4.10 [1.67-10.07]; ACE-sleep: B = 0.57 [0.15-1.00]; ACE-emotional: B = 0.92 [0.35-1.49]), and gastrointestinal history (ACE-physical: B = 1.25 [0.41-2.10]) were multivariable predictors of worse outcomes. At 6-months, psychiatric (GOSE ≤ 6: OR = 2.57 [1.38-4.77]; ACE-physical: B = 1.38 [0.68-2.09]; ACE-cognitive: B = 0.74 [0.28-1.20]; ACE-sleep: B = 0.51 [0.20-0.83]; ACE-emotional: B = 0.93 [0.53-1.33]), and headache/migraine history (ACE-physical: B = 1.81 [0.79-2.84]) predicted worse outcomes. Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Maryse C. Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Hansen Deng
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Ryan R. L. Phelps
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Nathan A. Coss
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Sourabh Sharma
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Caitlin K. Robinson
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Catherine G. Suen
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Mary J. Vassar
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - David M. Schnyer
- Department of Psychology, University of Texas in Austin, Austin, TX, United States
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Raquel C. Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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