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系统综述:理论指导策略在促进家庭遗传风险沟通干预中的应用

A systematic review of theory-informed strategies used in interventions fostering family genetic risk communication.

机构信息

Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.

Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.

出版信息

Patient Educ Couns. 2022 Jul;105(7):1953-1962. doi: 10.1016/j.pec.2022.03.009. Epub 2022 Mar 11.

Abstract

BACKGROUND

Inherited risk is a family issue. Identifying family members who carry a pathogenic genetic variant that increases risk of cancers and other chronic diseases can be lifesaving for those affected.

OBJECTIVE

The research questions are: (1) which family communication frameworks have been applied, (2) how do intervention strategies employed map to these theories, and (3) to what extent were families receptive to these strategies and communication increased?

METHODS

Manuscripts published between January 2010 and August 2020 were searched in three databases: PubMed, PsycINFO, and Web of Science.

RESULTS

Nine intervention trials were identified. All interventions were evaluated in clinical genetic counseling contexts using at least one individual-level strategy (e.g. increase knowledge). Only three focused on dyadic conversations such as preparing for relatives' information needs.

CONCLUSIONS

This systematic review posed the question whether theoretically based approaches have been applied to foster family genetic risk communication. Greater attention needs to be paid to the utilization of dyadic level and family system level theories to guide intervention developments.

PRACTICAL IMPLICATIONS

We conclude by calling for accelerating and broadening the development of interventions to enable family communication about inherited risk that are theory-based, incorporate family-systems thinking, and are conducted outside of specialty clinic settings.

摘要

背景

遗传风险是一个家庭问题。识别携带增加癌症和其他慢性疾病风险的致病性遗传变异的家庭成员,对于受影响的人来说是救命的。

目的

研究问题是:(1)已经应用了哪些家庭沟通框架,(2)所采用的干预策略如何映射到这些理论,以及(3)家庭在多大程度上接受了这些策略并增加了沟通?

方法

在 2010 年 1 月至 2020 年 8 月期间,在三个数据库中搜索了已发表的手稿:PubMed、PsycINFO 和 Web of Science。

结果

确定了九项干预试验。所有干预措施都在临床遗传咨询环境中使用了至少一种个体层面的策略(例如增加知识)进行了评估。只有三项专注于对偶对话,例如为亲属的信息需求做准备。

结论

本系统评价提出了一个问题,即是否已经应用了基于理论的方法来促进家庭遗传风险沟通。需要更加关注对偶层面和家庭系统层面理论的利用,以指导干预措施的发展。

实际意义

我们最后呼吁加快和扩大干预措施的开发,以便能够进行基于理论、纳入家庭系统思维、并在专科诊所环境之外进行的关于遗传风险的家庭沟通。

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