Women's preferences for cancer risk management strategies in Lynch syndrome

Purpose Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. Patients and Methods This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. Results Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. Conclusion The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline.

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Decision aids for female BRCA mutation carriers: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-045075 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045075

Author(s):

Sarah A McGarrigle ◽

Geraldine Prizeman ◽

Carol Spillane ◽

Niamh Byrne ◽

Amanda Drury ◽

...

Keyword(s):

Ovarian Cancer ◽

Risk Management ◽

Scoping Review ◽

Brca Mutation ◽

Decision Aids ◽

Management Strategies ◽

Mutation Carriers ◽

Risk Management Strategies ◽

Brca Mutation Carriers ◽

Cancer Risk Management

IntroductionWomen who inherit a pathogenic mutation in Breast Cancer Susceptibility Genes 1 or 2 (BRCA1 or BRCA2) are at substantially higher risk of developing breast and ovarian cancer than the average woman. Several cancer risk management strategies exist to address this increased risk. Decisions about which risk management strategies to choose are complex, personal and multifactorial for these women. This scoping review will map evidence relevant to cancer risk management decision making in BRCA mutation carriers without a personal history of cancer. The objective is to identify and describe the features of patient decision aids that have been developed for BRCA mutation carriers. This information may be beneficial for designing new decision aids or adapting existing decision aids to support decision making in this population.Methods and analysisThis scoping review will be conducted according to the Joanna Briggs Institute’s scoping review methodological framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used for guidance. Studies on decision aids for women with a BRCA mutation who are unaffected by breast or ovarian cancer will be considered for inclusion. Five electronic databases will be searched (MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science) with no restrictions applied for language or publication date. Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results.Ethics and disseminationEthical approval for conducting this scoping review is not required as this study will involve secondary analysis of existing literature. Findings will be published in a peer-reviewed journal and presented at relevant conferences.

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Uptake of cancer risk management strategies among women who undergo cascade genetic testing for breast cancer susceptibility genes

Cancer ◽

10.1002/cncr.33668 ◽

2021 ◽

Author(s):

Sukh Makhnoon ◽

Grace Tran ◽

Brooke Levin ◽

Kristin D. Mattie ◽

Brian Dreyer ◽

...

Keyword(s):

Breast Cancer ◽

Risk Management ◽

Genetic Testing ◽

Cancer Susceptibility ◽

Management Strategies ◽

Breast Cancer Susceptibility ◽

Cancer Susceptibility Genes ◽

Breast Cancer Susceptibility Genes ◽

Risk Management Strategies ◽

Cancer Risk Management

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“Left in limbo”: Exploring how patients with colorectal cancer interpret and respond to a suspected Lynch syndrome diagnosis

Hereditary Cancer in Clinical Practice ◽

10.1186/s13053-021-00201-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Nicole den Elzen ◽

Sharelle L. Joseland ◽

Sibel Saya ◽

Sowmya Jonnagadla ◽

Joanne Isbister ◽

...

Keyword(s):

Risk Management ◽

Cancer Risk ◽

Lynch Syndrome ◽

Genetic Test ◽

Cancer Genetics ◽

Test Results ◽

Genetic Test Results ◽

Genetics Services ◽

Management Advice ◽

Cancer Risk Management

Abstract Background A diagnosis of suspected Lynch syndrome (SLS) is given when a tumour displays characteristics consistent with Lynch syndrome (LS), but no germline pathogenic variant is identified. This inconclusive diagnosis results in uncertainty around appropriate cancer risk management. This qualitative study explored how patients with CRC interpret and respond to an SLS diagnosis. Methods Semi-structured telephone interviews were conducted with 15 patients with CRC who received an SLS diagnosis, recruited from cancer genetics services across Australia. Interviews were transcribed verbatim and analysed using thematic analysis. Participant responses were compared with appointment summary letters from cancer genetics services. Results Participants’ interpretations of genetic test results were found to vary widely. While this variation often aligned with variation in interpretations by cancer genetics services, participants also had difficulties with the complexity and recall of genetic test results. Participants had a range of psychological responses to the uncertainty that their results presented, from relief to disappointment and doubt. Cancer risk perceptions also varied widely, with participants’ interpretations of their genetic test results just one of several influencing factors. Despite this variability, almost all participants adhered to cancer risk management advice, although different participants received different advice. All participants also communicated any cancer risk management advice to first-degree relatives, motivated by protecting them, but information communicated was not always consistent with advice received. Conclusions Our study findings highlight the variability in patients’ interpretations of their diagnosis, cancer risk management and family communication when a diagnosis of SLS is received, and provide novel insights into how healthcare professionals can better support patients with SLS.

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Helping supervisees learn ethically based risk management strategies

PsycEXTRA Dataset ◽

10.1037/e500672008-001 ◽

2008 ◽

Author(s):

Samuel Knapp

Keyword(s):

Risk Management ◽

Management Strategies ◽

Risk Management Strategies

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The management of risk in a dryland environment

Proceedings of the New Zealand Grassland Association ◽

10.33584/jnzg.2011.73.2835 ◽

2011 ◽

pp. 13-21

Author(s):

D.I. Gray ◽

J.I. Reid ◽

D.J. Horne

Keyword(s):

Risk Management ◽

Service Providers ◽

Management Strategies ◽

Subterranean Clover ◽

Farming Systems ◽

Market Risk ◽

Farm Size ◽

Forage Crops ◽

Risk Management Strategies ◽

Upside Risk

A group of 24 Hawke's Bay hill country farmers are working with service providers to improve the resilience of their farming systems. An important step in the process was to undertake an inventory of their risk management strategies. Farmers were interviewed about their farming systems and risk management strategies and the data was analysed using descriptive statistics. There was considerable variation in the strategies adopted by the farmers to cope with a dryland environment. Importantly, these strategies had to cope with three types of drought and also upside risk (better than expected conditions), and so flexibility was critical. Infra-structure was important in managing a dryland environment. Farmers chose between increased scale (increasing farm size) and geographic dispersion (owning a second property in another location) through to intensification (investing in subdivision, drainage, capital fertiliser, new pasture species). The study identified that there may be scope for further investment in infra-structural elements such as drainage, deeper rooting alternative pasture species and water harvesting, along with improved management of subterranean clover to improve flexibility. Many of the farmers used forage crops and idling capacity (reduced stocking rate) to improve flexibility; others argued that maintaining pasture quality and managing upside risk was a better strategy in a dryland environment. Supplementary feed was an important strategy for some farmers, but its use was limited by contour and machinery constraints. A surprisingly large proportion of farmers run breeding cows, a policy that is much less flexible than trading stock. However, several farmers had improved their flexibility by running a high proportion of trading cattle and buffer mobs of ewe hoggets and trade lambs. To manage market risk, the majority of farmers are selling a large proportion of their lambs prime. Similarly, cattle are either sold prime or store onto the grass market when prices are at a premium. However, market risk associated with the purchase of supplements and grazing was poorly managed.

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The Effects of Decision Aid Orientation on Risk Factor Identification and Audit Test Planning

Auditing A Journal of Practice & Theory ◽

10.2308/aud.2002.21.2.39 ◽

2002 ◽

Vol 21 (2) ◽

pp. 39-56 ◽

Cited By ~ 29

Author(s):

Jean C. Bedard ◽

Lynford E. Graham

Keyword(s):

Risk Factors ◽

Risk Management ◽

Decision Aid ◽

Decision Aids ◽

Management Strategies ◽

Risk Identification ◽

Matched Pair ◽

Audit Planning ◽

Audit Firms ◽

Risk Management Strategies

In auditing, risk management involves identifying client facts or issues that may affect engagement risk, and planning evidence-gathering strategies accordingly. The purpose of this paper is to examine whether auditors' identification of risk factors and planning of audit tests is affected by decision aid orientation, i.e., a “negative” focus wherein client risk and its consequences are emphasized, or a “positive” focus where such factors are not emphasized. Specifically, we expect that auditors will identify more risk factors using a negatively oriented risk identification decision aid, but only when engagement risk is relatively high. We address this issue in the context of auditors' knowledge of actual clients, manipulating decision aid orientation as negative or positive in a matched-pair design. Results show that auditors using the negative decision aid orientation identify more risk factors than do those using a positive orientation, for their higher-risk clients. We also find that decisions to apply substantive tests are more directly linked to specific risk factors identified than to direct risk assessments. Further, our results show that auditors with repeat engagement experience with the client identify more risk factors. The findings of this study imply that audit firms may improve their risk management strategies through simple changes in the design of decision aids used to support audit planning.

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