Cancer Genetic Counseling: Communication and Counselees’ Post-Visit Satisfaction,Cognitions, Anxiety,and Needs Fulfillment

Little is known about the relation between communication during cancer genetic counseling and outcome. We assessed associations between counselor-counselee communication and counselee satisfaction, cognitions, anxiety, and fulfillment of major needs, corrected for pre-visit levels as appropriate. In total 171 consecutive new counselees, mainly referred for breast or colon cancer, received pre- and post-visit questionnaires assessing needs/fulfillment, knowledge, perceived control (PPC), anxiety (STAI), and satisfaction. Initial visits were videotaped and counselor eye gaze was recorded. Verbal communication was rated by Roter Interaction Analysis System (RIAS). Asking more medical questions was associated with lower satisfaction levels. Receiving more medical information was related to higher correct knowledge scores, higher reported fulfillment of some needs, and unrelated to perceptions of control. Receiving more psychosocial information and longer counselor eye gaze were related to higher anxiety scores. Longer visits were related to higher correct knowledge scores. Providing medical information appears the most powerful communication aspect to increase counselee satisfaction and address needs. More research is needed on how to address adequately (emotional) needs and increase feelings of control.     

Who Is at Risk for Psychological Distress in Genetic Testing Programs for Hereditary Cancer Disorders?

Presymptomatic identification of disease gene carriers is becoming an increasingly common part of the clinical management of hereditary cancer disorders. With an expected increase in the number of requests for DNA testing and the limited resources for counseling, the amount of time genetic counselors are able to spend with test candidates will decrease. It is therefore important for counselors to identify persons at risk for psychological distress. Based on a review of experiences with Huntington disease and cancer patients, we describe factors likely to evoke distress in genetic cancer candidates. We also discuss the sometimes widely different ways that test candidates and their partners respond to genetic testing. By exploring risk factors for distress in relevant domains of the research, we can offer counselors guidelines for determining who may need extra counseling.     

Midwives’ Approach to Genetic Diseases and Genetic Counseling in Denizli, Turkey

The purpose of this study was to evaluate Denizli midwives’ self-reported knowledge of genetic diseases and genetic counseling. Data was collected on forms that obtained information about midwives approaches to basic genetics, genetic disorders, and genetic counseling (response rate = 70.1%). The highest response rate of midwives describing themselves as “knowledgeable” about basic genetic information was for mitosis and meiosis with 4.8%, about genetic disorders was for phenylketonuria with 61.1%, and about genetic counseling was for recommending ultrasonography during pregnancy with 98.1%. The source for basic genetics information for 56.4% of participants was in their school level classes. None of the midwives felt that they had sufficient knowledge about genetic counseling or screening and 76.4% would like to attend an educational course. Even though the midwives have recognized their knowledge deficit they occasionally give genetic counseling. As a result of this study a genetics course is planned for midwives so they can actively participate in the prevention and early diagnosis of genetic diseases.     

Counselees’ Expressed Level of Understanding of the Risk Estimate and Surveillance Recommendation are Not Associated with Breast Cancer Surveillance Adherence

We studied counselees’ expressed understanding of the risk estimate and surveillance recommendation in the final consultation for breast cancer genetic counseling in relation with their risk perception, worry and cancer surveillance adherence 1 year post-counseling. Consecutive counselees were included from 2008 to 2010. Counselees with an indication for diagnostic DNA-testing for themselves or a breast cancer affected relative were requested to complete online questionnaires before and after counseling and one year after counseling (N?=?152–124). Self-reported surveillance was compared to surveillance recommendations. Consultations were videotaped. Counselees’ reactions to the risks and recommendations were coded. Statements about the risk perception and surveillance intentions of breast cancer unaffected counselees were transcribed. Associations with outcomes were explored. Almost all breast cancer unaffected counselees (>90 %) reacted to their risk estimate with an utterance indicating understanding and this reaction was not significantly associated with their post-visit risk perception alignment. Over one-third (38.6 %) overestimated their risk post-counseling. Few counselees (5.8 %) expressed surveillance intentions. One year after counseling, about three-quarters (74.0 %) of the breast cancer unaffected counselees had adhered to the surveillance recommendation. Almost one-quarter (23.3 %) had performed more mammograms/MRI scans than recommended, which was associated with prior mammography uptake (n?=?47; X ² ?=?5.2; p?=?.02). Counselees’ post-counseling overestimation of their risk, high levels of worry and high surveillance uptake were not reflected in their reactions to the counselor’s information during the final visit.     

Parkinson’s Disease: Patients’ Knowledge,Attitudes, and Interest in Genetic Counseling

The objective of this study was to assess the genetics knowledge of patients with Parkinson’s disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson’s Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score?=?26, range?=?9–35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β?=?0.6, p?<?0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.     

Changes in Specialists’ Perspectives on Cancer Genetic Testing,Prophylactic Surgery and Insurance Discrimination: Then and Now

We surveyed cancer genetics specialists in 1998 to learn what they would do if at 50 % risk to carry a BRCA or Lynch syndrome mutation. We chose to repeat our study 14 years later, to examine how perspectives have changed with the extensive data now available. In July 2012 we surveyed the National Society of Genetic Counselors (NSGC) Cancer Special Interest Group via an internet based survey. We found statistically significant increases in the percentage of specialists who: would undergo BRCA testing (p?=?0.0006), opt for prophylactic bilateral mastectomy (p =0.0001), opt for prophylactic removal of their uterus and ovaries for Lynch syndrome (p =0.0057 and P?=?0.0090, respectively), and bill testing to insurance (p >0.0001). There were also statistically significant decreases in the percentage of participants who would have their colon removed for Lynch syndrome (p?=?0.0002) and use an alias when pursuing testing (p?>?0.0001). Over the past 14 years there has been a major change in perspective amongst cancer genetic specialists regarding genetic testing, prophylactic surgery and insurance discrimination.     

High School Biology/Life Science Teachers’ Presentation of Genetic Counseling and Health Care Career Options in Their Classrooms

Studies show teachers play an influential role in the career decision-making process of students and early knowledge of genetic counseling (GC) increases the likelihood students will consider this career option. This quantitative study is the first to explore the presentation of GC and other health care career options by high school (HS) biology/life science (B/LS) teachers in their classrooms. Our findings indicate most B/LS teachers present GC as a career option to HS students, agree it complements classroom activities, and perceive students as interested in learning about the profession. However, teachers note many barriers to spending class time presenting GC careers. Consequently, a substantial number of teachers spent a minimal amount of time presenting health care careers in general. We discuss ways genetic counselors can enhance career resources, reduce barriers, and foster student interest in pursuing a career in GC by developing partnerships with HS B/LS teachers.     

Helping Couples Fulfill the “Highest of Life’s Goals”: Mate Selection,Marriage Counselling,and Genetic Counseling in United States

This article traces the history of modern genetic counseling to mate selection and marriage counselling practices of the early-20th century. Mate selection revolved around a belief that human heredity could be improved and genetic diseases eradicated through better breeding. Marriage counselling, though interested in reproduction, was also concerned with the emotional and psychological well-being of couples. These two practices coalesced most obviously in the work of well-known geneticist Sheldon Reed. Even as marriage and genetic counselling diverged in the post-WWII period, vestiges of these practices remain in contemporary counseling experiences with family planning and genetic screening programs. Emphasizing points of continuity between “positive” eugenic ideologies and modern genetic practices elaborates the diverse origins of genetic counseling. It also exposes how genetic counselors have become involved in genetic enterprises beyond standard clinical settings, and prods at key issues in the interaction between genetic science and social values.     

Life Trajectories, Genetic Testing, and Risk Reduction Decisions in 18–39 Year Old Women at Risk for Hereditary Breast and Ovarian Cancer

This qualitative study identified four life trajectories that influenced the decision in young women to have genetic testing for mutations in BRCA1/2 and subsequent risk reduction decisions after receiving a positive mutation result. Fifty nine women between the ages of 18–39 years were interviewed in this grounded theory study, 44 of those tested were found to have a mutation in either BRCA1 or BRCA2. Of those with a mutation, 23 had no history of cancer and 21 had a breast cancer diagnosis. Analysis of the 44 participants tested found that risk reducing decisions were related to the life trajectories that preceded genetic testing. These life trajectories included: 1) Long-standing awareness of breast cancer in the family, 2) Loss of one’s mother to breast cancer at a young age, 3) Expression of concern by a health care provider, and 4) Personal diagnosis of breast cancer. Understanding possible influences behind decision making for genetic testing and risk reduction in young women may assist health care providers in offering age appropriate guidance and support.     

Quality of Life in Pediatric Cancer Patients: The Relationships Among Parents’ Characteristics,Children’s Characteristics,and Informant Concordance

As advancements in the treatment of childhood cancer have resulted in increasing survival rates, the psychosocial functioning of child patients has become an increasingly important issue. In this pilot study, we investigate the relationships among parents’ characteristics, children’s characteristics, and the quality of life experienced by children who are diagnosed with cancer. Forty-seven mothers, sixteen fathers, and nineteen children completed measures about their own psychological functioning as well as measures about the children’s quality of life. Mothers’ ratings of their children’s quality of life were correlated positively with the ratings provided by both fathers and the children themselves. In addition, significant relationships were found between mothers’ depression and parenting stress and children’s quality of life as well as between mothers’ and fathers’ anxiety and children’s quality of life. Finally, using regression analyses, mothers’, fathers’, and children’s ratings of their own characteristics predicted significantly their ratings of the children’s quality of life. The importance of examining the psychological characteristics of family members when assessing the quality of life of children who are diagnosed with cancer is discussed.     

Marital Relationship,Body Image and Psychological Quality of Life among Breast Cancer Patients: The Moderating Role of the Disease’s Phases

In this cross-sectional study we analyzed the links between marital quality and intimacy, body image, and psychological quality of life (PQoL) of breast cancer patients, as well as the moderating role of cancer phase (treatment, survivorship) on the aforementioned links. We also evaluated whether body image mediated the associations between marital relationship variables and PQoL. An analysis of the data from 128 patients (66 undergoing treatment, 62 survivors) indicated that the majority of links between variables were significant only during the treatment phase. Mediating effect of body image on the associations between relationship variables and PQoL was found only at the treatment phase.     

Lower Cancer Rates Among Druze Compared to Arab and Jewish Populations in Israel, 1999–2009

The Druze are a small ethnic minority in Israel amounting to about 130,000 residents (or 1.7 % of the total population of the country). Unlike other population groups, the Druze strive to keep their own traditions and marry mainly inside their own community. During the last decade, cancer morbidity among both Jews and Arabs in Israel has been increasing, while data on the Druze are little known and have not been analyzed and compared to other population groups to date. To compare cancer morbidity rates among Druze, Arabs and Jews in Israel during 1999–2009, gender-specific and age-standardized incidence rates of all site cancers and specific cancers of three population groups (Jews, Arabs and Druze) were received from the Israel National Cancer Registry for the period 1999–2009. Based on these rates, periodical incidence rates were calculated and mutually compared across the groups stratified by gender. As the analysis shows, the Druze had significantly lower cancer rates compared to both Arabs and Jews. Thus, for all site cancers, there were significantly higher cancer rates in Jewish males versus Druze males (RR = 1.39, 95 % CI = 1.16–1.65) and in Jewish females versus Druze females (RR = 1.53, 95 % CI = 1.27–1.85), but not statistically significant for Arab males versus Druze males (RR = 1.12 95 % CI = 0.93–1.35). Lung cancer rates in Arab males were also higher compared to Druze males (RR = 1.84, 95 % CI = 1.13–3.00). Jewish males had statistically significant higher rates of prostate cancer compared to Druze males (RR = 2.47, 95 % CI = 1.55–3.91). For thyroid and colon cancers, risks were not significantly different at the 95 % CI level; however, the risks were significantly different at the 90 % CI level (RR = 3.62, 90 % CI 1.20–11.02 and RR = 1.69, 90 % CI = 1.03–2.77, respectively). Jewish females had significantly higher rates of invasive breast cancer (RR = 2.25, 95 % CI = 1.55–3.25), in situ cervical cancer (RR = 4.01, 95 % CI = 1.27–12.66) and lung cancer (RR = 3.22, 95 % CI = 1.12–9.24) compared to Druze females. We thus observed lower cancer rates among Druze versus Arab and Jewish populations in Israel. A reason for these differences may be due to different nutritional habits. Druze still keep a less processed nutritional lifestyle, than is common in industrial society. There may also be other reasons that have not been identified yet.     

Psychological ethical climate,leader–member exchange and commitment to superior customer value: influencing salespeople’s unethical intent and sales performance

In today’s competitive environment, salespeople are challenged with creating customer value in an ethical manner while meeting performance goals. Sales supervisors play a critical role in ensuring that this challenge is met. This research examines the roles of psychological ethical climate and leader–member exchange (LMX) in encouraging salespeople’s commitment to providing superior customer value, reducing their unethical intentions and improving sales performance. Results indicate that business-to-business salespeople’s psychological ethical climate perceptions influence their perceived relationship with their sales supervisor (i.e. LMX relationship) as well as their commitment to providing superior customer value. LMX also directly influences commitment to providing superior customer value, which in turn affects salespeople’s unethical intent and quota performance. Theoretical and managerial implications based on the study’s findings are provided, as well as directions for future research.     

The Effect of Color on the Production of Responses to Rorschach Cards VIII,IX, and X in Age Groups of 11–12 and 15–16 Years

The effect of color on the production of responses to the Rorschach task has been considered by investigators from 2 different positions: (a) that color has little effect on the production of responses, and (b) that color increases the number of responses. Some previous results found by the current investigators have supported the first position for the last 3 fully colored Rorschach cards (VIII, IX, and X), in children from 5 to 12 years old. Other studies of ours, however, have confirmed the second position for these same cards with a group of young adults 17 to 23 years old. As there was no increase of responses up to age 12, for this study we hypothesized a developmental effect in adolescence such that there would be an increase in the production of responses to the colored Rorschach cards at the age of 15 to 16 years, and this is what the results indicate. From a pragmatic standpoint, these results imply a revision of interpretive meaning for the Color and Affective Ratio variables in children's protocols. Our results also indicate that color cannot be regarded as a means of expression of affect at age 11 to 12 like it will be from age 15 to 16 and on.     

How Variations in Parents’ Use of Confrontive and Coercive Control Relate to Variations in Parent–Adolescent Conflict,Adolescent Disclosure,and Parental Knowledge: Adolescents’ Perspective

Benefits and drawbacks of parental control exercised in relation to adolescents continue to be debated in socialization research with greater emphasis being placed on the benefits of parental autonomy-granting than parental control. We examined the relations between maternal and paternal control and parent–adolescent conflict frequency and intensity as well as parental knowledge of adolescent activities and adolescents’ disclosure of their activities to parents. Adolescents in grades 10 and 12 were interviewed about parenting practices their parents employed when regulating 18 adolescent activities. Thirty-seven parenting practices emerged from which authoritarian, directive, authoritative, democratic, and unengaged parenting clusters were derived. Adolescents whose mothers and fathers were classified as directive or authoritative reported less conflict with parents, more disclosure to parents, and more parental knowledge than adolescents whose mothers and fathers were classified as authoritarian. Coercive control practices of authoritarian parents as well as nondemanding practices of unengaged parents and to some extent of democratic parents were related to more negative parent–child relationship indicators than was the extensive use of firm/confrontive control (rational-demanding) by directive parents or authoritative parents. Evidence herein supports the conclusion that even for middle and late adolescents, parental control that is rational and firm is related to beneficial parent–child relationship qualities. Therefore, practitioners should underscore the importance of continued parental control during adolescence not just of autonomy-granting.     

The Relationships of Family Socioeconomic Status, Parent–Adolescent Conflict, and Filial Piety to Adolescents’ Family Functioning in Mainland China

This study used structural equation modeling to examine the relationships of family socioeconomic status (SES), parent–adolescent conflict, and filial piety to family functioning among middle school and high school students in mainland China. A total of 2,341 students (1,218 girls and 1,096 boys; mean age = 15.42) completed the Chinese Family Assessment Instrument, Family Status Survey, Parent–adolescent Conflict Scale, and Filial Piety Scale. The main results showed that: (a) family SES, parent–adolescent conflict, and filial piety were significantly linked to family functioning; (b) parent–adolescent conflict and filial piety contributed more to family functioning than family SES; (c) parent–adolescent conflict mediated the relationship between reciprocal filial piety and family functioning. The results promote understanding of family processes that influence the relationships between family SES, parent–adolescent conflict, filial piety, and family functioning among middle school and high school adolescents in mainland China.