Genetics in cancer care: confronting a Pandora's Box of dilemmas.

PURPOSE/OBJECTIVES: To provide an overview of sociopolitical, bioethical, and psychological issues emerging from the application of genetic technologies in cancer care in the United States and to provoke oncology nurses to consider the impact that advances in genetics may have on their practice.

DATA SOURCES

Published professional articles, tests, and proceedings as well as government and lay publications.

DATA SYNTHESIS

This article reviews underlying sociopolitical issues and forecasts bioethical dilemmas and psychological responses likely to emerge from expanding genetic screening and treatment options in oncology. The sociopolitical issues revolve around individual rights, the role of government, and the influence of religious dogma and public perception. The bioethical dilemmas fall within a framework of five scenarios, and a range of psychological responses are described.

CONCLUSIONS

Significant changes will occur in cancer care as a result of advances in genetic technology. These changes will be accompanied by a new set of dilemmas in clinical practice and by as yet undescribed psychological responses. In addition to building a knowledge base relevant to these new technologies, oncology nurses must anticipate the new dilemmas and be prepared to manage the emotional responses of their patients.

NURSING IMPLICATIONS

Nurse are in a strategic position to make significant contributions to the genetics data base by designing and conducting research to describe the ethical dilemmas and patient/family responses engendered as genetic science is integrated into cancer care.