Abstract
Genetic testing for hereditary breast and ovarian cancer reveals significant risk information regarding one's chances of developing cancer that has potential implications for patients and their families. This study reports on the motivations and attitudes of index patients and their relatives towards genetic testing for hereditary breast and ovarian cancer. In total, 10 female index patients and 20 of their relatives were interviewed regarding their experiences of communicating genetic information within their families, and their motivations and attitudes towards genetic testing. The analysis found two types of ‘family groups’: groups strongly committed to genetic testing and groups uncertain about testing. Within committed family groups, index patients and their relatives felt obliged to be tested for others, leading some relatives to be tested without having fully thought through their decision or the implications of knowing their mutation status. These family groups also described considerations in relation to the value of testing for themselves. In family groups uncertain about testing, relatives had not attended for predictive testing, had postponed decision making until some point in the future or had expressed ambivalence about the value of testing for themselves. Results suggest the value of explicitly acknowledging motivations for genetic testing within the context of family obligations, relationships and communication, and the possible value of involving family members in genetic counselling and decision making from a family's first contact with genetic services.
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References
McIntosh A, Shaw C, Evans G et al: Clinical Guidelines and Evidence Review for the Classification and Care of Women at Risk of Familial Breast Cancer. London: National Collaborating Centre for Primary Care/University of Sheffield. NICE guideline CG014, 2004, updated 2006.
Gaff CL, Clarke AJ, Atkinson P et al: Process and outcome in communication of genetic information within families: a systematic review. Eur J Hum Genet 2007; 15: 999–1011.
Hallowell N : Doing the right thing: genetic risk and responsibility. Sociol Health Illn 1999; 21: 597–621.
Smith JA, Michie S, Stephenson M, Quarrell O : Risk perception and decision-making processes in candidates for genetic testing for Huntington's disease: an interpretative phenomenological analysis. J Health Psychol 2002; 7: 131–144.
Etchegary H, Miller F, Delaat S, Wilson B, Carroll J, Cappelli M : Decision-making about inherited cancer risk: exploring dimensions of genetic responsibility. J Genet Couns 2009; 18: 252–264.
Jacobs LA, Deatrick JA : The individual, the family and genetic testing. J Prof Nurs 2009; 15: 313–324.
Lerman C, Croyle R : Psychological issues in genetic testing for breast-cancer susceptibility. Arch Intern Med 1994; 154: 609–616.
Hallowell N, Foster C, Eeles R, Ardern-Jones A, Murday V, Watson M : Balancing autonomy and responsibility: the ethics of generating and disclosing genetic information. J Med Ethics 2003; 29: 74–79.
Mellon S, Berry-Bobovski L, Gold R, Levin N, Tainsky M : Family communication and decision making regarding inherited breast/ovarian cancer risk information. Oncol Nurs Forum 2005; 32: 193.
d’Agincourt-Canning L : Genetic testing for hereditary breast and ovarian cancer: responsibility and choice. Qual Health Res 2006; 16: 97–118.
Rowley E : On doing ‘being ordinary’: women's accounts of BRCA testing and maternal responsibility. New Genet Soc 2007; 26: 241–250.
Foster C, Watson M, Moynihan C, Ardern-Jones A, Eeles R : Genetic testing for breast and ovarian cancer predisposition: cancer burden and responsibility. J Health Psychol 2002; 7: 469–484.
Landsbergen K, Verhaak C, Kraaimaat F, Hoogerbrugge N : Genetic uptake in BRCA-mutation families is related to emotional and behavioral communication characteristics of index patients. Fam Cancer 2005; 4: 115–119.
Finlay E, Stopfer JE, Burlingame E et al: Factors determining dissemination of results and uptake of genetic testing in families with known BRCA1/2 mutations. Genet Test 2008; 12: 81–91.
Durant J, Hansen A, Bauer M : Public understanding of the new genetics; in Marteau TM, Richards M (eds): The Troubled Helix: Social and Psychological Implications of the New Human Genetics. Cambridge: Cambridge University Press, 1999, pp 235–248.
Smith JA, Flowers P, Larkin M : Interpretative Phenomenological Analysis. London: Sage, 2009.
Miles MB, Huberman AM : Qualitative Data Analysis: An Expanded Sourcebook, (2nd edn). London: Sage, 1994.
Ritchie J, Spencer L : Qualitative data analysis for applied policy research; in Bryman A, Burgess R (eds): Analyzing Qualitative Data. London: Routledge, 1994, pp 173–194.
Gilligan C : In a Different Voice: Psychological Theory and Women's Development. London: Harvard University Press, 1982.
Hallowell N, Arden-Jones A, Eeles R et al: Guilt, blame and responsibility: men's understanding of their role in the transmission of BRCA1/2 mutations within their family. Sociol Health Illn 2006; 28: 969–988.
Hallowell N, Ardern-Jones A, Eeles R et al: Communication about genetic testing in families of male BRCA1/2 carriers and non-carriers: patterns, priorities and problems. Clin Genet 2005; 67: 492–502.
Lynch HT, Snyder C, Lynch JF et al: Patient responses to the disclosure of BRCA mutation tests in hereditary breast-ovarian cancer families. Cancer Genet Cytogenet 2006; 165: 91–97.
Kenen R : The human genome project: creator of the potentially sick, potentially vulnerable and potentially stigmatised?; in Robinson I (ed): Life and Death Under High Technology Medicine. Manchester: Manchester University Press, 1994, pp 49–64.
Hamilton R, Williams JK, Bowers BJ, Calzone K : Life trajectories, genetic testing and risk reduction decisions in 18–39 year old women at risk for hereditary breast and ovarian cancer. J Genet Counsel 2009; 18: 147–159.
Foster C, Evans DGR, Eeles R et al: Non-uptake of predictive genetic testing for BRCA1/2 among relatives of known carriers: attributes, cancer worry, and barriers to testing in a multicenter clinical cohort. Genet Test 2004; 8: 23–29.
Gooding HC, Organista K, Burack J, Biesecker BB : Genetic susceptibility testing from a stress and coping perspective. Soc Sci Med 2006; 62: 1880–1890.
Shiloh S, Ilan S : To test or not to test? Moderators of the relationship between risk perceptions and interest in predictive genetic testing. J Behav Med 2005; 28: 467–479.
Acknowledgements
This study was funded by the UK Department of Health Grant (HSR06). We thank the genetics services for help in recruitment and the patients and relatives who participated.
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… Indicates editorial elision in which non-relevant material has been omitted.
[text] Indicates explanatory text added by authors.
F stands for family in transcript identifier; F1 is family 1.
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Dancyger, C., Smith, J., Jacobs, C. et al. Comparing family members’ motivations and attitudes towards genetic testing for hereditary breast and ovarian cancer: a qualitative analysis. Eur J Hum Genet 18, 1289–1295 (2010). https://doi.org/10.1038/ejhg.2010.114
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DOI: https://doi.org/10.1038/ejhg.2010.114
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