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护理人员对全外显子测序中意义未明变异的认知及对患有未确诊疾病儿童的相关经历。

Caregivers' perception of and experience with variants of uncertain significance from whole exome sequencing for children with undiagnosed conditions.

作者信息

Li Xin, Nusbaum Rachel, Smith-Hicks Constance, Jamal Leila, Dixon Shannan, Mahida Sonal

机构信息

Master's in Genetic Counseling Training Program, University of Maryland School of Medicine, Baltimore, Maryland.

Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland.

出版信息

J Genet Couns. 2019 Apr;28(2):304-312. doi: 10.1002/jgc4.1093. Epub 2019 Jan 24.

Abstract

Despite its promising diagnostic yield, whole exome sequencing (WES) frequently introduces variant(s) of uncertain significance (VUS), which have been speculated to cause parental stress and anxiety. This study aimed to explore the psychosocial impact of receiving a VUS from pediatric WES on caregivers and to identify implications for clinical practice. Fourteen telephone interviews were conducted with parents or legal guardians who received VUS results from their child's WES to assess their understanding of the result, affective responses, perceived impact, and adaptation. Our content analysis showed that most participants had a good understanding of the purpose of the test and the majority of them recalled the result category. Most participants deemed the result had no impact thus far on their perception of their child's condition. However, one participant reported feelings of fear related to the VUS. Most participants experienced a range of emotions from receiving the result. The majority of participants reported that this result did not significantly alter their child's care or their ability to take care of their child, and three participants reported empowerment. Additionally, several participants expressed an interest in research studies and peer support groups dedicated to families with a VUS identified on WES. Our study elicited new information about the psychosocial impact of receiving a VUS from WES. This insight may help to guide pre- and post-WES counseling in the future.

摘要

尽管全外显子组测序(WES)在诊断方面具有可观的成效,但它经常会引入意义不明确的变异(VUS),据推测这些变异会给父母带来压力和焦虑。本研究旨在探讨儿童WES检测出的VUS对照顾者的心理社会影响,并确定其对临床实践的启示。我们对14位从孩子的WES检测中收到VUS结果的父母或法定监护人进行了电话访谈,以评估他们对结果的理解、情感反应、感知到的影响以及适应情况。我们的内容分析表明,大多数参与者对检测目的有很好的理解,并且他们中的大多数人记得结果类别。大多数参与者认为该结果目前对他们对孩子病情的认知没有影响。然而,有一位参与者报告了与VUS相关的恐惧情绪。大多数参与者在收到结果后经历了一系列情绪。大多数参与者报告称,这个结果并没有显著改变他们对孩子的照料方式或他们照顾孩子的能力,有三位参与者表示从中获得了力量。此外,几位参与者表达了对致力于WES检测出VUS的家庭的研究和同伴支持小组的兴趣。我们的研究得出了关于收到WES检测出的VUS的心理社会影响的新信息。这一见解可能有助于指导未来WES检测前后的咨询工作。

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