Genetic Counseling in the Era of Genomics: What’s all the Fuss about?

As genomic sequencing becomes more widely available in clinical settings for diagnostic purposes, a number of genetic counseling issues are gaining precedence. The ability to manage these issues will be paramount as genetic and non-genetic healthcare professionals navigate the complexities of using genomic technologies to facilitate diagnosis and inform patient management. Counseling issues arising when counseling for diagnostic genomic sequencing were identified by four genetic counselors with 10 years of collective experience providing genetic counseling in this setting. These issues were discussed and refined at a meeting of genetic counselors working in clinical genomics settings in Melbourne, Australia. Emerging counseling issues, or variations of established counseling issues, were identified from the issues raised. Illustrative cases were selected where pre- and post-test genetic counseling was provided in clinical settings to individuals who received singleton or trio WES with targeted analysis. Counseling issues discussed in this paper include a reappraisal of how genetic counselors manage hope in the genomic era, informed consent for secondary use of genomic data, clinical reanalysis of genomic data, unexpected or unsolicited secondary findings, and trio sequencing. The authors seek to contribute to the evolving understanding of genetic counseling for diagnostic genomic sequencing through considering the applicability of existing genetic counseling competencies to managing emerging counseling issues and discussing genetic counseling practice implications.     

Patients’ Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> Testing

This paper explores patients’ views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients’ views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test’s timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.     

The Financial Burden of Having Children and Fertility Differentials Across Development and Life Stages: Evidence from Satisfaction Data

Comparing the financial burden of having children across countries accompanies various types of measurement issues. The present study employs financial satisfaction to overcome the measurement issues and examines how the financial burden of having children differs across development stages. The challenge in this approach lies in detecting the impact of having children on financial satisfaction. To address this challenge, we focus our attention on the peculiar movement of satisfaction in the financial domain of life, which is measured by standardizing financial satisfaction by overall life satisfaction, and perform regression analyses using World and European Integrated Values Survey. The results show that the negative impact of having an additional child on satisfaction becomes particularly greater in the financial domain as income increases and total fertility rate (TFR) decreases. The results also indicate that having children offers a sense of financial security to the elderly in high TFR countries while this is not the case in lower TFR countries. These results support the general idea that the heavier financial burden of having children is a major cause of fertility decline and provide policy implications to find a way out of extremely low fertility.     

Gratitude and Life Satisfaction in the United States and Japan

Being grateful has been associated with many positive outcomes, including greater happiness, positive affect, optimism, and self-esteem. There is limited research, however, on the associations between gratitude and different domains of life satisfaction across cultures. The current study examined the associations between gratitude and three domains of life satisfaction, including satisfaction in relationships, work, and health, and overall life satisfaction, in the United States and Japan. A total of 945 participants were drawn from two samples of middle aged and older adults, the Midlife Development in the United States and the Midlife Development in Japan. There were significant positive bivariate associations between gratitude and all four measures of life satisfaction. In addition, after adjusting for demographics, neuroticism, extraversion, and the other measures of satisfaction, gratitude was uniquely and positively associated with satisfaction with relationships and life overall but not with satisfaction with work or health. Furthermore, results indicated that women and individuals who were more extraverted and lived in the United States were more grateful and individuals with less than a high school degree were less grateful. The findings from this study suggest that gratitude is uniquely associated with specific domains of life satisfaction. Results are discussed with respect to future research and the design and implementation of gratitude interventions, particularly when including individuals from different cultures.     

Semantic Ambiguity: Do Multiple Meanings Inhibit or Facilitate Word Recognition?

It is not clear whether multiple unrelated meanings inhibit or facilitate word recognition. Some studies have found a disadvantage for words having multiple meanings with respect to unambiguous words in lexical decision tasks (LDT), whereas several others have shown a facilitation for such words. In the present study, we argue that these inconsistent findings may be due to the approach employed to select ambiguous words across studies. To address this issue, we conducted three LDT experiments in which we varied the measure used to classify ambiguous and unambiguous words. The results suggest that multiple unrelated meanings facilitate word recognition. In addition, we observed that the approach employed to select ambiguous words may affect the pattern of experimental results. This evidence has relevant implications for theoretical accounts of ambiguous words processing and representation.     

The Relationship Between Automatic Thoughts and Irrational Beliefs Predicting Anxiety and Depression

Cognitive behavioral approaches differ in their views on core cognitions and their hypothesized role in the etiology of depression and anxiety. The present study provides empirical evidence regarding the relationship between irrational beliefs and components of automatic thoughts and their role in the etiology of depression and anxiety. The present study utilized newer and improved questionnaires to assess components of irrational belief. Based on prior research by Safren et al. (Cogn Ther Res 24(3):327–344, 2000), a three-factor structure of the combined automatic thought questionnaires were utilized to measure components of automatic thoughts as they relate to depression and anxiety. Factor analytical methods were utilized to confirm the factor structure of the irrational beliefs and automatic thoughts components. Advanced path modeling was utilized to model the relationship between irrational beliefs and automatic thoughts in predicting anxiety and depression. The study used a sample of N = 542 undergraduate psychology students during stressful exam times. Results indicated that the irrational belief Demandingness represents a primary factor, followed by the secondary irrational beliefs as proposed by Rational Emotive Behavioral Theory. Selfdowning beliefs were fully mediated by depressive automatic thoughts in the case of depressive affect. Low frustration tolerance contributed unique variance to anxious and depressive affect that was not fully mediated by automatic thoughts. Results from the present study add empirical evidence that irrational beliefs indeed represent core and intermediary beliefs that lead to specific automatic thoughts, which is congruent with cognitive behavioral theory as proposed by Rational Emotive Behavioral Therapy.     

Agreement and Updating For Self-Locating Belief

In this paper, I argue that some plausible principles concerning which credences are rationally permissible for agents given information about one another’s epistemic and credal states have some surprising consequences for which credences an agent ought to have in light of self-locating information. I provide a framework that allows us to state these constraints and draw out these consequences precisely. I then consider and assess the prospects for rejecting these prima facie plausible principles.     

The development and validation of an implicit measure of competence need satisfaction

Research on self-determination theory has typically relied on explicit measures when examining the concept of competence need satisfaction. As a result, we know relatively little about competence need satisfaction that arises under conditions of automaticity. Across four studies, we developed and validated implicit measures of competence need satisfaction by drawing on two tasks: a relational variant of the implicit association test (IAT; Study 1, 3, and 4) and the implicit relational assessment procedure (IRAP; Study 2–3). Results across these studies revealed that both implicit measures were either unrelated or moderately related to their explicit counterpart. They were also unrelated to one another. Unlike the IRAP, the IAT was found to be reliable, to display discriminant validity, and to yield meaningful but modest relations with constructs in a nomological network. Together, these results provide modest support for the usefulness of the competence need satisfaction IAT but not of the competence need satisfaction IRAP as an implicit measure of the need for competence. Future research examining the unique predictive value of this IAT is needed, together with research on possible explanations for the low reliability of the IRAP.     

The relevance of being “on the same page” to succeed as a project team: A moderated mediation model

Taking a motivational approach, this study deepens the role of team members’ shared understanding of the work to be done in a project team setting. More specifically, the goal of this study is to test a second stage moderated mediation model in which the mediating role of team members’ proactive behavior in the relationship between perceived shared understanding and team performance is moderated by team adaptability. Based on a multisource and multimethod approach, data were collected from 111 teams of undergraduate and graduate students (521 participants) participating in a project management simulation. Results support the hypothesized moderated mediation model. Indeed, the results indicate that the relationship between perceived shared understanding and team performance is mediated by proactive behavior. The results also show that the relationship between proactive behavior and team performance is moderated by team adaptability. Overall, results reveal that the indirect effect of perceived shared understanding on team performance is moderated by team adaptability, such that this indirect effect is stronger when the level of team adaptability is high. In terms of practical implications, the study highlights the importance of fostering the perception of being “on the same page” in order to motivate members to be proactive and to enhance project team performance.     

Storytelling agents: why narrative rather than mental time travel is fundamental

I propose that we can explain the contribution of mental time travel to agency through understanding it as a specific instance of our more general capacity for narrative understanding. Narrative understanding involves the experience of a pre-reflective and embodied sense of self, which co-emerges with our emotional involvement with a sequence of events (Velleman 2003). Narrative understanding of a sequence of events also requires a ‘recombinable system’, that is, the ability to combine parts to make myriad sequences. Mental time travel shares these two characteristics: it involves an embodied sense of self and the ability to create novel scenarios. What is unique about mental time travel is that it is a story explicitly about our selves, and it involves metarepresentation. Agency is enabled by narrative understanding when we are able to put our current situation into a larger narrative context, whereby some possible actions, but not others, make sense. However, new features of agency are enabled when we understand stories that are explicitly about our selves: we gain the ability to plan and act on plans.