Richardson Jordan P, Ahlawat Nivedita, Riggan Kirsten A, Close Sharron, Allyse Megan A
Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
J Community Genet. 2022 Dec;13(6):619-628. doi: 10.1007/s12687-022-00604-0. Epub 2022 Aug 19.
Sex chromosome multisomies (SCMs) are genomic conditions with variable phenotypes that range from undetectable to requiring extensive clinical intervention. Currently, many individuals with SCMs are diagnosed in adolescence or adulthood based on physical symptoms related to pubertal development and infertility. Given the expansion of genetic testing in routine clinical practice, the diagnosing clinician is increasingly a primary care or family medicine provider. This study aims to help providers better understand the patient experience of receiving a diagnosis. We conducted a survey of individuals (n = 55) with SCMs using closed and open-ended questions. Open-response questions were qualitatively analyzed and are reported here with the descriptive results of the closed-ended questions. Most participants were diagnosed with 47,XXY (n = 51; 85.0%), identified as White race/ethnicity (n = 46; 88.5%), and were college graduates or higher (n = 29; 54.7%). Many participants reported dissatisfaction with the delivery of the diagnosis, expressing that it was rushed and their provider lacked detailed information about the condition. Participants were frustrated by the general lack of availability of high-quality informational resources from both medical and other sources at the time of diagnosis. Some participants also described the social and psychological impact of the diagnosis and how it was delivered. To the best of our knowledge, this is the largest survey of individuals diagnosed with SCMs, which is notable considering their prevalence and low diagnostic rate. Our findings provide patient-informed insight on how to improve the delivery of SCM diagnoses, especially delivery in a primary care setting, including the provision of up-to-date information and proactive referral to specialty care and counseling services.
性染色体多体性(SCMs)是一种基因组状况,其表型各异,从难以察觉至需要广泛的临床干预。目前,许多患有SCMs的个体是在青春期或成年期基于与青春期发育和不孕相关的身体症状而被诊断出来的。鉴于基因检测在常规临床实践中的扩展,进行诊断的临床医生越来越多地是初级保健或家庭医学提供者。本研究旨在帮助提供者更好地理解患者接受诊断的体验。我们使用封闭式和开放式问题对55名患有SCMs的个体进行了调查。对开放式回答问题进行了定性分析,并在此与封闭式问题的描述性结果一并报告。大多数参与者被诊断为47,XXY(n = 51;85.0%),被认定为白人种族/族裔(n = 46;88.5%),并且是大学毕业生或学历更高(n = 29;54.7%)。许多参与者报告对诊断的传达不满意,称诊断过程仓促,且他们的提供者缺乏关于该病症的详细信息。参与者对诊断时普遍缺乏来自医学和其他来源的高质量信息资源感到沮丧。一些参与者还描述了诊断及其传达方式所带来的社会和心理影响。据我们所知,这是对被诊断患有SCMs的个体进行的最大规模调查,考虑到其患病率和低诊断率,这一点值得注意。我们的研究结果为如何改进SCMs诊断的传达提供了基于患者的见解,特别是在初级保健环境中的传达,包括提供最新信息以及主动转诊至专科护理和咨询服务。