Dilzell Kristen, Kingham Kerry, Ormond Kelly, Ladabaum Uri
Department of Genetics, Stanford University, Stanford, CA, USA.
Fam Cancer. 2014 Sep;13(3):381-9. doi: 10.1007/s10689-014-9720-9.
Facilitating family communication about Lynch syndrome is a public health priority since following appropriate screening guidelines can decrease morbidity and mortality. The aims of this study were to (1) ascertain what educational materials individuals with Lynch syndrome provide to at-risk relatives, and (2) identify relationships between receiving educational materials and pursuing clinical follow-up. Seventy-four participants, recruited from the Stanford Cancer Institute and a support group, completed an online questionnaire; 50 were first to be diagnosed with a Lynch syndrome mutation in their family (probands) and 24 were first or second-degree relatives. Probands reported informing 88 % (184/209) of first-degree relatives and 64 % (161/252) of second-degree relatives of the mutation. Probands shared their genetic counseling note with 53 % of relatives; other resources, including family letters, personal notes, testing laboratory information, online resources, support group information, and genetics referrals, were given to 33 % or fewer relatives. Probands reported that female relatives (p = 0.028) and first-degree relatives (p ≤ 0.001) were more likely to be given materials. Relatives who received an educational material were more likely to follow up with a clinician (74 vs 22 %, p ≤0.001) and attend a genetic counseling appointment (43 vs 16 %, p ≤ 0.001). First-degree relatives who received an educational material were more likely to have undergone genetic testing (51 vs 19 %, p = 0.012) and cancer screening (69 vs 29 %, p = 0.001). Facilitating information transmission in families with Lynch syndrome using educational materials may play a role in informed clinical decision-making and cascade screening of at-risk relatives.
促进林奇综合征患者家庭之间的沟通是一项公共卫生重点工作,因为遵循适当的筛查指南可以降低发病率和死亡率。本研究的目的是:(1)确定林奇综合征患者会向有患病风险的亲属提供哪些教育材料;(2)确定接收教育材料与寻求临床随访之间的关系。从斯坦福癌症研究所和一个支持小组招募了74名参与者,他们完成了一份在线问卷;其中50人是其家族中首个被诊断出林奇综合征突变的患者(先证者),24人是一级或二级亲属。先证者报告称,已将该突变告知88%(184/209)的一级亲属和64%(161/252)的二级亲属。先证者与53%的亲属分享了他们的遗传咨询记录;其他资源,包括家信、个人笔记、检测实验室信息、在线资源、支持小组信息和遗传学转诊信息,提供给的亲属比例均不超过33%。先证者报告称,女性亲属(p = 0.028)和一级亲属(p≤0.001)更有可能收到相关材料。收到教育材料的亲属更有可能寻求临床医生的后续治疗(74%对22%,p≤0.001)并参加遗传咨询预约(43%对16%,p≤0.001)。收到教育材料的一级亲属更有可能接受过基因检测(51%对19%,p = 0.012)和癌症筛查(69%对29%,p = 0.001)。利用教育材料促进林奇综合征患者家庭中的信息传播,可能在临床决策和对有患病风险亲属的级联筛查中发挥作用。