1
|
Campbell-Salome G, Jones LK, Walters NL, Morgan KM, Brangan A, Ladd IG, McGowan MP, Wilemon K, Schmidlen TJ, Simmons E, Schwartz MLB, McMinn MN, Tricou E, Rahm AK, Ahmed CD, Sturm AC. Optimizing communication strategies and designing a comprehensive program to facilitate cascade testing for familial hypercholesterolemia. BMC Health Serv Res 2023; 23:340. [PMID: 37020233 PMCID: PMC10074725 DOI: 10.1186/s12913-023-09304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This project aimed to optimize communication strategies to support family communication about familial hypercholesterolemia (FH) and improve cascade testing uptake among at-risk relatives. Individuals and families with FH provided feedback on multiple strategies including: a family letter, digital tools, and direct contact. METHODS Feedback from participants was collected via dyadic interviews (n = 11) and surveys (n = 98) on communication strategies and their proposed implementation to improve cascade testing uptake. We conducted a thematic analysis to identify how to optimize each strategy. We categorized optimizations and their implementation within the project's healthcare system using a Traffic Light approach. RESULTS Thematic analysis resulted in four distinct suggested optimizations for each communication strategy and seven suggested optimizations that were suitable across all strategies. Four suggestions for developing a comprehensive cascade testing program, which would offer all optimized communication strategies also emerged. All optimized suggestions coded green (n = 21) were incorporated. Suggestions coded yellow (n = 12) were partially incorporated. Only two suggestions were coded red and could not be incorporated. CONCLUSIONS This project demonstrates how to collect and analyze stakeholder feedback for program design. We identified feasible suggested optimizations, resulting in communication strategies that are patient-informed and patient-centered. Optimized strategies were implemented in a comprehensive cascade testing program.
Collapse
Affiliation(s)
- Gemme Campbell-Salome
- Department of Genomic Health, Geisinger, , Danville, PA, USA.
- Department of Population Health Sciences, Geisinger, Danville, PA, USA.
| | - Laney K Jones
- Department of Genomic Health, Geisinger, , Danville, PA, USA
- Geisinger Heart and Vascular Institute, Geisinger, Danville, PA, USA
| | | | - Kelly M Morgan
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Andrew Brangan
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Ilene G Ladd
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Mary P McGowan
- The Family Heart Foundation, Pasadena, CA, USA
- Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | - Marci L B Schwartz
- Cardiac Genome Clinic, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, ON, Canada
| | - Megan N McMinn
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Eric Tricou
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Alanna K Rahm
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | | | - Amy C Sturm
- Department of Genomic Health, Geisinger, , Danville, PA, USA
- Geisinger Heart and Vascular Institute, Geisinger, Danville, PA, USA
| |
Collapse
|
3
|
Campbell-Salome G, Jones LK, Masnick MF, Walton NA, Ahmed CD, Buchanan AH, Brangan A, Esplin ED, Kann DG, Ladd IG, Kelly MA, Kindt I, Kirchner HL, McGowan MP, McMinn MN, Morales A, Myers KD, Oetjens MT, Rahm AK, Schmidlen TJ, Sheldon A, Simmons E, Snir M, Strande NT, Walters NL, Wilemon K, Williams MS, Gidding SS, Sturm AC. Developing and Optimizing Innovative Tools to Address Familial Hypercholesterolemia Underdiagnosis: Identification Methods, Patient Activation, and Cascade Testing for Familial Hypercholesterolemia. Circ Genom Precis Med 2021; 14:e003120. [PMID: 33480803 PMCID: PMC7892261 DOI: 10.1161/circgen.120.003120] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Familial hypercholesterolemia (FH) is the most common cardiovascular genetic disorder and, if left untreated, is associated with increased risk of premature atherosclerotic cardiovascular disease, the leading cause of preventable death in the United States. Although FH is common, fatal, and treatable, it is underdiagnosed and undertreated due to a lack of systematic methods to identify individuals with FH and limited uptake of cascade testing. Methods and Results: This mixed-method, multi-stage study will optimize, test, and implement innovative approaches for both FH identification and cascade testing in 3 aims. To improve identification of individuals with FH, in Aim 1, we will compare and refine automated phenotype-based and genomic approaches to identify individuals likely to have FH. To improve cascade testing uptake for at-risk individuals, in Aim 2, we will use a patient-centered design thinking process to optimize and develop novel, active family communication methods. Using a prospective, observational pragmatic trial, we will assess uptake and effectiveness of each family communication method on cascade testing. Guided by an implementation science framework, in Aim 3, we will develop a comprehensive guide to identify individuals with FH. Using the Conceptual Model for Implementation Research, we will evaluate implementation outcomes including feasibility, acceptability, and perceived sustainability as well as health outcomes related to the optimized methods and tools developed in Aims 1 and 2. Conclusions: Data generated from this study will address barriers and gaps in care related to underdiagnosis of FH by developing and optimizing tools to improve FH identification and cascade testing.
Collapse
Affiliation(s)
- Gemme Campbell-Salome
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Laney K Jones
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Max F Masnick
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Nephi A Walton
- Intermountain Precision Genomics, Intermountain Healthcare, St. George, UT (N.A.W.)
| | - Catherine D Ahmed
- The Familial Hypercholesterolemia Foundation, Pasadena, CA (C.D.A., M.P.M., K.D.M., A.S., K.W.)
| | - Adam H Buchanan
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Andrew Brangan
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | | | - David G Kann
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Ilene G Ladd
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Melissa A Kelly
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | | | - H Lester Kirchner
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Mary P McGowan
- The Familial Hypercholesterolemia Foundation, Pasadena, CA (C.D.A., M.P.M., K.D.M., A.S., K.W.).,Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH (M.P.M.)
| | - Megan N McMinn
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Ana Morales
- Invitae, San Francisco, CA (E.D.E., A.M., E.S., M.S.)
| | - Kelly D Myers
- The Familial Hypercholesterolemia Foundation, Pasadena, CA (C.D.A., M.P.M., K.D.M., A.S., K.W.)
| | - Matthew T Oetjens
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Alanna Kulchak Rahm
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Tara J Schmidlen
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Amanda Sheldon
- The Familial Hypercholesterolemia Foundation, Pasadena, CA (C.D.A., M.P.M., K.D.M., A.S., K.W.)
| | | | - Moran Snir
- Invitae, San Francisco, CA (E.D.E., A.M., E.S., M.S.)
| | - Natasha T Strande
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Nicole L Walters
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Katherine Wilemon
- The Familial Hypercholesterolemia Foundation, Pasadena, CA (C.D.A., M.P.M., K.D.M., A.S., K.W.)
| | - Marc S Williams
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Samuel S Gidding
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| | - Amy C Sturm
- Geisinger, Danville, PA (G.C.-S., L.K.J., M.F.M., A.H.B., A.B., D.G.K., I.G.L., M.A.K., H.L.K., M.N.M., M.T.O., A.K.R., T.J.S., N.T.S., N.L.W., M.S.W., S.S.G., A.C.S.)
| |
Collapse
|