The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study
Abstract
:1. Introduction
- (1)
- comparing women’s cancer worry after receiving or not receiving clinically actionable genetic information from lifepool as measured by the cancer worry scale; and
- (2)
- exploring outcomes including cancer risk perception, uptake of cancer risk management strategies, the experience of receiving and adapting to the information, and how the information is communicated to at-risk family members.
2. Materials and Methods
2.1. Setting and Sample Population
2.2. Participants, Sampling, and Recruitment
2.3. Data Collection
- Domain 1. Demographics
- Domain 2. Genetic testing and risk management
- Domain 3. Cancer risk perception and cancer worry
- Domain 4. Impact of cancer risk assessment
- Domain 5. Psychological adaptation
- Domain 6. Family communication
2.4. Measures
2.5. Interviews
2.6. Data Analysis
2.6.1. Quantitative
2.6.2. Qualitative
3. Results
3.1. Demographics
3.2. Uptake of Confirmatory Genetic Testing and Cancer Risk Management Strategies
I had to wait nine weeks. I think that was probably the hardest part for me… if people have been kind enough to give their time and their energy to research, I think you probably could expedite that process for them in a way. Rather than just let them wait in the system.(Bridget, 54 years, BRCA2)
Before I told anybody, I had to have a second test done, which took maybe six weeks and I think that was probably the worst time of anxiety for me, knowing, but not saying anything, because I wanted to be a hundred percent sure. That [test] actually took a lot longer and was a lot more badly organised. It was an extra month past the time that it was received by [hospital], to when I was actually advised, so I don’t know why that delay was there? I think that could have been handled better.(Evie, 51 years, BRCA2)
3.3. Decision-Making and Motivation Regarding Cancer Risk Management
I was told I’d need to have scans and breast checks alternatively, six-monthly. Why would you do that for the rest of your life until they actually say, “Oh, yes, now we’ve found a lump”? I mean … that’s crazy to me, sitting on a time bomb going “Oh well, they’ll check me every six months and one day they might find a lump”. You’d say “why didn’t I just get that done at the start?” To me, the choice of having [breast] surgery was a no-brainer.(Evie, 51 years, BRCA2)
[The doctor’s] summary was, “Well Theresa, you’d be pissed if you didn’t do anything and you got ovarian cancer, wouldn’t you?” And I thought, “That sums it up, doesn’t it?” It’s been brought to my attention and if removing the ovaries is a 100% certainty that you won’t get it… I’ve got an appointment in three weeks to see the gynaecological cancer specialist person about my ovaries.(Theresa, 59 years, BRCA2)
I looked into [RRM] and thought it was pretty drastic and then the next option was the drug, the chemoprevention and so I looked into that as well and I weighed up the risks and decided not to do that. But I decided, yes, I would have my ovaries removed, because ovarian cancer is very hard to detect, whereas breast cancer is a slow growing and you can feel if there’s a lump, you can have a mammogram, and also, I was post-menopause. I didn’t really need my ovaries.(Elise, 55 years, BRCA2)
Well, I was at that age [where] my ovaries were probably not working that well anyway because I was 55 … I’d started menopause so it was no big deal.(Allison, 60 years, BRCA2)
3.4. Psychosocial Outcomes of Receiving Clinically Actionable Genetic Information
3.4.1. Breast Cancer Risk Perception after Notification
3.4.2. Ovarian Cancer Risk Perception after Notification
3.5. Cancer Worry after Notification
3.6. Women’s Reflections of Their Cancer Risk Perception and Cancer Worry
The percentage of ovarian cancer [risk] is quite high if you are BRCA2 positive. It’s from 11% to 25%. So, it’s quite alarmingly high, one in four. “So, I don’t know whether I’m the one in four, you don’t know. It’s still something that worries you at the back of the mind”.(Angela, 66 years, BRCA2)
“It just made me reassess … and even though I get it, even though you know what the [cancer] risk is in numbers, when you actually experience someone going through cancer, it does actually highlight the risk and make your perception of that risk a bit more attuned, I would say. So I think that that was like, “OK I don’t want to go through that.” This is a real thing not just an academic thing”.(Sharon, 75 years, BRCA2)
“That plays on my mind a bit now, every twinge or any pain you get you’re like, “Oh, what if, what if, what if”, and I think I was like that pre getting my breasts removed. [It] was that every lump, everything would just play on my mind. I was always getting checked, and it was almost like a paranoia thing. But once they [my breasts] were gone, that was alleviated. I think once my ovaries are gone, a bit more of that anxiousness will be gone as well”.(Lucy, 36 years, BRCA2)
3.7. Distress, Uncertainty, and Positive Experiences after Notification
3.8. Adapting to Genetic Information Provided by Lifepool
3.9. Family Communication
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Resta, R.; Biesecker, B.B.; Bennett, R.L.; Blum, S.; Hahn, S.E.; Strecker, M.N.; Williams, J.L. A new definition of Genetic Counseling: National Society of Genetic Counselors’ Task Force report. J. Genet. Couns. 2006, 15, 77–83. [Google Scholar] [CrossRef]
- Rolland, J.S. Families and genetic fate: A millennial challenge. Fam. Syst. Health 1999, 17, 123–132. [Google Scholar] [CrossRef]
- Tibben, A.; Vegter-van der Vlis, M.; Skraastad, M.I.; Frets, P.G.; van der Kamp, J.J.; Niermeijer, M.F.; van Ommen, G.J.; Roos, R.A.; Rooijmans, H.G.; Stronks, D.; et al. DNA-testing for Huntington’s disease in The Netherlands: A retrospective study on psychosocial effects. Am. J. Med. Genet. 1992, 44, 94–99. [Google Scholar] [CrossRef] [PubMed]
- Biesecker, B.B.; Erby, L.H.; Woolford, S.; Adcock, J.Y.; Cohen, J.S.; Lamb, A.; Lewis, K.V.; Truitt, M.; Turriff, A.; Reeve, B.B. Development and validation of the Psychological Adaptation Scale (PAS): Use in six studies of adaptation to a health condition or risk. Patient Educ. Couns. 2013, 93, 248–254. [Google Scholar] [CrossRef] [Green Version]
- McAllister, M.; Payne, K.; Macleod, R.; Nicholls, S.; Dian, D.; Davies, L. Patient empowerment in clinical genetics services. J. Health Psychol. 2008, 13, 895–905. [Google Scholar] [CrossRef]
- Forrest, L.; Delatycki, M.; Curnow, L.; Skene, L.; Aitken, M. Genetic Health Professionals and the Communication of Genetic Information in Families: Practice During and After a Genetic Consultation. Am. J. Med. Genet. Part A 2010, 152, 1458–1466. [Google Scholar] [CrossRef]
- Schwartz, M.L.B.; McCormick, C.Z.; Lazzeri, A.L.; Lindbuchler, D.M.; Hallquist, M.L.G.; Manickam, K.; Buchanan, A.H.; Rahm, A.K.; Giovanni, M.A.; Frisbie, L.; et al. A Model for Genome-First Care: Returning Secondary Genomic Findings to Participants and Their Healthcare Providers in a Large Research Cohort. Am. J. Hum. Genet. 2018, 103, 328–337. [Google Scholar] [CrossRef] [Green Version]
- Trainer, A.H.; Thompson, E.; James, P.A. BRCA and beyond: A genome-first approach to familial breast cancer risk assessment. Discov. Med. 2011, 12, 433–443. [Google Scholar]
- Mirshahi, U.L.; Kim, J.; Best, A.F.; Chen, Z.E.; Hu, Y.; Haley, J.S.; Golden, A.; Stahl, R.; Manickam, K.; Carr, A.G.; et al. A Genome-First Approach to Characterize DICER1 Pathogenic Variant Prevalence, Penetrance, and Phenotype. JAMA Netw. Open 2021, 4, e210112. [Google Scholar] [CrossRef]
- Schwartz, M.L.B.; Buchanan, A.H.; Hallquist, M.L.G.; Haggerty, C.M.; Sturm, A.C. Genetic counseling for patients with positive genomic screening results: Considerations for when the genetic test comes first. J. Genet. Couns. 2021, 30, 634–644. [Google Scholar] [CrossRef]
- D’Agincourt-Canning, L. The effect of experiential knowledge on construction of risk perception in hereditary breast/ovarian cancer. J. Genet. Couns. 2005, 14, 55–69. [Google Scholar] [CrossRef] [PubMed]
- Sivell, S.; Elwyn, G.; Gaff, C.L.; Clarke, A.J.; Iredale, R.; Shaw, C.; Dundon, J.; Thornton, H.; Edwards, A. How risk is perceived, constructed and interpreted by clients in clinical genetics, and the effects on decision making: Systematic review. J. Genet. Couns. 2008, 17, 30–63. [Google Scholar] [CrossRef] [PubMed]
- Willis, A.M.; Smith, S.K.; Meiser, B.; James, P.A.; Ballinger, M.L.; Thomas, D.M.; Yanes, T.; Young, M.-A. Influence of lived experience on risk perception among women who received a breast cancer polygenic risk score: ‘Another piece of the pie’. J. Genet. Couns. 2021, 30, 849–860. [Google Scholar] [CrossRef] [PubMed]
- Austin, J.C. Re-conceptualizing risk in genetic counseling: Implications for clinical practice. J. Genet. Couns. 2010, 19, 228–234. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Senay, I.; Kaphingst, K.A. Anchoring-and-adjustment bias in communication of disease risk. Med. Decis. Mak. 2009, 29, 193–201. [Google Scholar] [CrossRef]
- Forrest, L.E.; Young, M.A. Clinically Significant Germline Mutations in Cancer-Causing Genes Identified Through Research Studies Should Be Offered to Research Participants by Genetic Counselors. J. Clin. Oncol. 2016, 34, 898–901. [Google Scholar] [CrossRef]
- Willis, A.M.; Terrill, B.; Pearce, A.; McEwen, A.; Ballinger, M.L.; Young, M.-A. My Research Results: A program to facilitate return of clinically actionable genomic research findings. Eur. J. Hum. Genet. 2021, 30, 363–366. [Google Scholar] [CrossRef]
- Rowley, S.M.; Mascarenhas, L.; Devereux, L.; Li, N.; Amarasinghe, K.C.; Zethoven, M.; Lee, J.E.A.; Lewis, A.; Morgan, J.A.; Limb, S.; et al. Population-based genetic testing of asymptomatic women for breast and ovarian cancer susceptibility. Genet. Med. 2019, 21, 913–922. [Google Scholar] [CrossRef]
- O’Cathain, A.; Murphy, E.; Nicholl, J. The quality of mixed methods studies in health services research. J. Health Serv. Res. Policy 2008, 13, 92–98. [Google Scholar] [CrossRef]
- Forbes Shepherd, R.; Forrest, L.E.; Tutty, E.; Pearce, A.; Devereux, L.; James, P.A.; Campbell, I.G.; Trainer, A.H.; Young, M.-A. Unselected women’s experiences of receiving genetic research results for hereditary breast and ovarian cancer: A qualitative study. Genet. Test. Mol. Biomark. 2021, 25, 741–748. [Google Scholar] [CrossRef]
- Harris, P.A.; Taylor, R.; Minor, B.L.; Elliott, V.; Fernandez, M.; O’Neal, L.; McLeod, L.; Delacqua, G.; Delacqua, F.; Kirby, J.; et al. The REDCap consortium: Building an international community of software platform partners. J. Biomed. Inf. 2019, 95, 103208. [Google Scholar] [CrossRef] [PubMed]
- Harris, P.A.; Taylor, R.; Thielke, R.; Payne, J.; Gonzalez, N.; Conde, J.G. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inf. 2009, 42, 377–381. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Weinstein, N.D.; Kwitel, A.; McCaul, K.D.; Magnan, R.E.; Gerrard, M.; Gibbons, F.X. Risk perceptions: Assessment and relationship to influenza vaccination. HealthPsychol. 2007, 26, 146–151. [Google Scholar] [CrossRef] [PubMed]
- Gurmankin Levy, A.; Shea, J.; Williams, S.V.; Quistberg, A.; Armstrong, K. Measuring Perceptions of Breast Cancer Risk. Cancer Epidemiol. Biomark. Prev. 2006, 15, 1893. [Google Scholar] [CrossRef] [Green Version]
- Custers, J.A.; van den Berg, S.W.; van Laarhoven, H.W.; Bleiker, E.M.; Gielissen, M.F.; Prins, J.B. The cancer worry scale: Detecting fear of recurrence in breast cancer survivors. Cancer Nurs. 2014, 37, E44–E50. [Google Scholar] [CrossRef]
- Cella, D.; Hughes, C.; Peterman, A.; Chang, C.-H.; Peshkin, B.N.; Schwartz, M.D.; Wenzel, L.; Lemke, A.; Marcus, A.C.; Lerman, C. A brief assessment of concerns associated with genetic testing for cancer: The Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire. Health Psychol. 2002, 21, 564. [Google Scholar] [CrossRef]
- Cohen, J. Statistical Power Analysis for the Behavioural Sciences, 2nd ed.; Lawrence Erlbaum Associates: New York, NY, USA, 1988. [Google Scholar]
- Braun, V.; Clarke, V.; Hayfield, N.; Terry, G. Thematic Analysis. In Handbook of Research Methods in Health Social Sciences; Liamputtong, P., Ed.; Springer: Singapore, 2019; pp. 843–860. [Google Scholar]
- MacQueen, K.M.; McLellan, E.; Kay, K.; Millstein, B. Codebook Development for Team-Based Qualitative Analysis. Field Methods 1998, 10, 31–36. [Google Scholar] [CrossRef]
- Eijzenga, W.; Bleiker, E.M.; Ausems, M.G.; Sidharta, G.N.; Van der Kolk, L.E.; Velthuizen, M.E.; Hahn, D.E.; Aaronson, N.K. Routine assessment of psychosocial problems after cancer genetic counseling: Results from a randomized controlled trial. Clin. Genet. 2015, 87, 419–427. [Google Scholar] [CrossRef]
- Wevers, M.R.; Ausems, M.G.; Verhoef, S.; Bleiker, E.M.; Hahn, D.E.; Brouwer, T.; Hogervorst, F.B.; van der Luijt, R.B.; van Dalen, T.; Theunissen, E.B.; et al. Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial. Genet. Med. 2016, 18, 137–144. [Google Scholar] [CrossRef] [Green Version]
- Watson, M.; Duvivier, V.; Wade Walsh, M.; Ashley, S.; Davidson, J.; Papaikonomou, M.; Murday, V.; Sacks, N.; Eeles, R. Family history of breast cancer: What do women understand and recall about their genetic risk? J. Med. Genet. 1998, 35, 731–738. [Google Scholar] [CrossRef] [Green Version]
- Esplen, M.J.; Harrington, S.; Leung, Y.W.; Aronson, M.; Rothenmund, H.; Semotiuk, K.; Wong, J.; Gallinger, S.; Dicks, E.; McLaughlin, J. Telephone versus in-person colorectal cancer risk and screening intervention for first-degree relatives: A randomized controlled trial. Cancer 2019, 125, 2272–2282. [Google Scholar] [CrossRef] [PubMed]
- Chirico, A.; Vizza, D.; Valente, M.; Iacono, M.L.; Campagna, M.R.; Palombi, T.; Alivernini, F.; Lucidi, F.; Bruno, F. Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors. Supportive Care Cancer 2022, 30, 2829–2837. [Google Scholar] [CrossRef]
- Athens, B.A.; Caldwell, S.L.; Umstead, K.L.; Connors, P.D.; Brenna, E.; Biesecker, B.B. A Systematic Review of Randomized Controlled Trials to Assess Outcomes of Genetic Counseling. J. Genet. Couns. 2017, 26, 902–933. [Google Scholar] [CrossRef] [Green Version]
- Smit, A.K.; Newson, A.J.; Best, M.; Badcock, C.A.; Butow, P.N.; Kirk, J.; Dunlop, K.; Fenton, G.; Cust, A.E. Distress, uncertainty, and positive experiences associated with receiving information on personal genomic risk of melanoma. Eur. J. Hum. Genet. 2018, 26, 1094–1100. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hamilton, J.G.; Symecko, H.; Spielman, K.; Breen, K.; Mueller, R.; Catchings, A.; Trottier, M.; Salo-Mullen, E.E.; Shah, I.; Arutyunova, A.; et al. Uptake and acceptability of a mainstreaming model of hereditary cancer multigene panel testing among patients with ovarian, pancreatic, and prostate cancer. Genet. Med. 2021, 23, 2105–2113. [Google Scholar] [CrossRef] [PubMed]
- Crook, A.; Plunkett, L.; Forrest, L.E.; Hallowell, N.; Wake, S.; Alsop, K.; Gleeson, M.; Bowtell, D.; Mitchell, G.; Australian Ovarian Cancer Study Group; et al. Connecting patients, researchers and clinical genetics services: The experiences of participants in the Australian Ovarian Cancer Study (AOCS). Eur. J. Hum. Genet. 2015, 23, 152–158. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Biesecker, B.B.; Erby, L. Adaptation to living with a genetic condition or risk: A mini-review. Clin. Genet. 2008, 74, 401–407. [Google Scholar] [CrossRef] [Green Version]
- Shapira, R.; Turbitt, E.; Erby, L.H.; Biesecker, B.B.; Klein, W.M.; Hooker, G.W. Adaptation of couples living with a high risk of breast/ovarian cancer and the association with risk-reducing surgery. Fam. Cancer. 2018, 17, 485–493. [Google Scholar] [CrossRef]
Demographic | Total | Group 1 PV | Group 2 No PV | p Value |
---|---|---|---|---|
Age (years) | n = 138 | n = 45 | n = 93 | |
Mean (SD) | 64.4 (6.7) | 65.2 (8.2) | 64.1 (5.8) | 0.4 |
Range | 37–79 | 37–79 | 48–77 | |
Education | n = 140 | n = 44 | n = 96 | |
Non-tertiary | 86 (61.4) | 26 (59.1) | 60 (62.5) | 0.7 |
Tertiary | 54 (38.6) | 18 (40.9) | 36 (37.5) | |
Income (per annum) | n = 140 | n = 44 | n = 96 | |
<$90,000AUD | 83 (59.3) | 23 (52.3) | 60 (62.5) | 0.3 |
>$90,000AUD | 57 (40.7) | 21 (47.7) | 36 (37.5) | |
Relationship | n = 141 | n = 45 | n = 96 | |
Partnered | 118 (83.7) | 39 (86.7) | 79 (82.3) | 0.5 |
Not partnered | 23 (16.3) | 6 (13.3) | 17 (17.7) | |
Children | n = 141 | n = 45 | n = 96 | |
Yes | 118 (83.7) | 42 (93.3) | 76 (79.2) | 0.03 * |
No | 23 (16.3) | 3 (6.7) | 20 (20.8) | |
Pathogenic variant | n = 141 | n = 45 | n = 96 | |
Not detected | 96 (68.1) | 0 (0) | 96 (100) | |
ATM | 1 (0.7) | 1 (2.2) | 0 (0) | |
BRCA1 | 2 (1.4) | 2 (4.4) | 0 (0) | |
BRCA2 | 24 (17.0) | 24 (53.3) | 0 (0) | |
PALB2 | 15 (10.6) | 15 (33.3) | 0 (0) | |
HBOC predisposition/Cannot recall | 3 (2.1) a | 3 (6.6) a | 0 (0) | |
Mean time since notification of genetic information (years) | n = 141 | n = 45 | n = 96 | |
Mean (SD) | n/a | 1.7 (1.5) | n/a | |
Range | n/a | 0.2–5.1 | n/a | |
Cancer history | n = 141 | n = 45 | n = 96 | |
No cancer | 126 (89.4) | 30 (66.7) | 96 (100) | |
Breast cancer | 9 (6.4) | 9 (20.0) | 0 (0) | |
Ovarian cancer | 1 (0.7) | 1 (2.2) | 0 (0) | |
Other cancer | 5 3.6) | 5 (11.1) | 0 (0) |
Clinical Outcomes | n (%) |
---|---|
Confirmatory genetic testing | n = 45 |
Complete | 43 (95.6) |
Waiting for FCC appointment | 1 (2.2) |
Undecided | 1 (2.2) |
Uptake of breast cancer risk management strategies | n = 45 |
High-risk breast screening | 27 (60.0) |
Chemoprevention a | 10 (22.2) |
Risk-reducing mastectomy | 6 (13.3) |
Uptake of ovarian cancer risk management strategies | n = 26 b |
Bilateral salpingo-oophorectomy | 14 (53.9) |
Breast Cancer Risk Perception | ||||
---|---|---|---|---|
Total | Group 1 PV | Group 2 No PV | p Value | |
Affective (0–3) | n = 141 | n = 45 | n = 96 | |
Range | 0–3 | 0–3 | 0–3 | Cohen’s d = 1.13 t = 6.2 (df 139) p < 0.001 * |
Mean (SD) | 0.9 (0.8) | 1.4 (0.8) | 0.6 (0.6) | |
95% CI | 0.7–1.0 | 1.1–1.6 | 0.5–0.7 | |
Cognitive (0–100) | n = 141 | n = 45 | n = 96 | |
Range | 0–80 | 0–80 | 0–80 | Cohen’s d = 0.85 t = 5.0 (df 139) p < 0.001 * |
Mean (SD) | 31.6 (21.6) | 43.8 (23.5) | 25.9 (18.1) | |
95% CI | 28.0–35.2 | 36.7–50.9 | 22.2–29.5 | |
Ovarian Cancer Risk Perception | ||||
Total | Group 1 PV | Group 2 No PV | p Value | |
Affective (0–3) | n = 125 | n = 29 | n = 96 | |
Range | 0–3 | 0–3 | 0–2 | Cohen’s d = 0.68 t = 4.1 (df 123) p < 0.001 * |
Mean (SD) | 0.6 (0.8) | 1.1 (1.1) | 0.5 (0.6) | |
95% CI | 0.5–0.8 | 0.7–1.6 | 0.4–0.6 | |
Cognitive (0–100) | n = 125 | n = 29 | n = 96 | |
Range | 0–100 | 0–100 | 0–70 | Cohen’s d = 0.28 t = 1.6 (df 123) p = 0.1 |
Mean (SD) | 24.4 (22.7) | 30.3 (34.3) | 22.7 (17.7) | |
95% CI | 20.4–28.5 | 17.2–43.3 | 19.1–26.3 |
Total | Group 1 PV | Group 2 No PV | p Value | |
---|---|---|---|---|
n = 141 | n = 45 | n = 96 | ||
Range | 8–25 | 10–25 | 8–22 | <0.001 * |
Mean (SD) | 13.6 (3.0) | 14.9 (3.1) | 13.1 (2.7) | |
95% CI | 13.2–14.1 | 13.9–15.8 | 12.5–13.6 | |
High cancer worry | 70 (49.7) | 30 (66.7) | 40 (41.7) | 0.01 * |
Low cancer worry | 71 (50.4) | 15 (33.3) | 56 (58.3) |
MICRA Sub-Scale | Mean (SD) | Reported Range |
---|---|---|
Distress (0–30) | 7.2 (6.9) | 0–26 |
Uncertainty (0–45) | 9.8 (6.0) | 0–24 |
Positive experiences (0–20) | 7.3 (4.9) | 0–20 |
TOTAL (0–95) | 27.4 (11.8) | 9–56 |
PAS Sub-Scale | Mean (SD) | Reported Range |
---|---|---|
Coping efficacy (4–20) | 12.9 (4.4) | 4–20 |
Self-esteem (5–25) | 13.7 (6.0) | 5–25 |
Social integration (3–15) | 8.2 (4.0) | 3–15 |
Spiritual wellbeing (3–15) | 8.8 (4.2) | 3–15 |
Total PAS (15–75) | 43.6 (16.5) | 15–75 |
Adaptation score | 2.9 (1.1) | 1–5 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Forrest, L.E.; Forbes Shepherd, R.; Tutty, E.; Pearce, A.; Campbell, I.; Devereux, L.; Trainer, A.H.; James, P.A.; Young, M.-A. The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study. J. Pers. Med. 2022, 12, 1112. https://doi.org/10.3390/jpm12071112
Forrest LE, Forbes Shepherd R, Tutty E, Pearce A, Campbell I, Devereux L, Trainer AH, James PA, Young M-A. The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study. Journal of Personalized Medicine. 2022; 12(7):1112. https://doi.org/10.3390/jpm12071112
Chicago/Turabian StyleForrest, Laura E., Rowan Forbes Shepherd, Erin Tutty, Angela Pearce, Ian Campbell, Lisa Devereux, Alison H. Trainer, Paul A. James, and Mary-Anne Young. 2022. "The Clinical and Psychosocial Outcomes for Women Who Received Unexpected Clinically Actionable Germline Information Identified through Research: An Exploratory Sequential Mixed-Methods Comparative Study" Journal of Personalized Medicine 12, no. 7: 1112. https://doi.org/10.3390/jpm12071112