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Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

1
Boston College, William F. Connell School of Nursing, Chestnut Hill, MA 02467, USA
2
Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA 02114, USA
3
Boston College, Department of Sociology, Chestnut Hill, MA 02467, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work as co-first authors.
Cancers 2020, 12(8), 2316; https://doi.org/10.3390/cancers12082316
Received: 15 June 2020 / Revised: 8 August 2020 / Accepted: 13 August 2020 / Published: 17 August 2020
Pathogenic germline variants in Breast Cancer 1/2 (BRCA) genes confer increased cancer risk. Understanding BRCA status/risk can enable family cascade screening and improve cancer outcomes. However, more than half of the families do not communicate family cancer history/BRCA status, and cancer outcomes differ according to parent of origin (i.e., maternally vs. paternally inherited pathogenic variant). We aimed to explore communication patterns around family cancer history/BRCA risk according to parent of origin. We analyzed qualitative interviews (n = 97) using template analysis and employed the Theory of Planned Behavior (TPB) to identify interventions to improve communication. Interviews revealed sub-codes of ‘male stoicism and ‘paternal guilt’ that impede family communication (template code: gender scripting). Conversely, ‘fatherly protection’ and ‘female camaraderie’ promote communication of risk. The template code ‘dysfunctional family communication’ was contextualized by several sub-codes (‘harmful negligence’, ‘intra-family ignorance’ and ‘active withdrawal of support’) emerging from interview data. Sub-codes ‘medical misconceptions’ and ‘medical minimizing’ deepened our understanding of the template code ‘medical biases’. Importantly, sub-codes of ‘informed physicians’ and ‘trust in healthcare’ mitigated bias. Mapping findings to the TPB identified variables to tailor interventions aimed at enhancing family communication of risk and promoting cascade screening. In conclusion, these data provide empirical evidence of the human factors impeding communication of family BRCA risk. Tailored, theory-informed interventions merit consideration for overcoming blocked communication and improving cascade screening uptake. View Full-Text
Keywords: BRCA mutation; cascade genetic testing; coping cancer; family communication; genetic testing; theory of planned behavior BRCA mutation; cascade genetic testing; coping cancer; family communication; genetic testing; theory of planned behavior
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MDPI and ACS Style

Dwyer, A.A.; Hesse-Biber, S.; Flynn, B.; Remick, S. Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening. Cancers 2020, 12, 2316. https://doi.org/10.3390/cancers12082316

AMA Style

Dwyer AA, Hesse-Biber S, Flynn B, Remick S. Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening. Cancers. 2020; 12(8):2316. https://doi.org/10.3390/cancers12082316

Chicago/Turabian Style

Dwyer, Andrew A.; Hesse-Biber, Sharlene; Flynn, Bailey; Remick, Sienna. 2020. "Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening" Cancers 12, no. 8: 2316. https://doi.org/10.3390/cancers12082316

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