Feasibility and Acceptability of a Culturally Sensitive Intervention To Promote Genetic Counseling

Background Despite the benefits of genetic counseling (GC) and testing, uptake of cancer genetic services is generally low and African American (AA) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of GC among AA women at risk for a hereditary breast cancer syndrome. We report here a pilot study to demonstrate feasibility and acceptability of incorporating this intervention in conjunction with population-based cancer risk assessment in a clinical setting with medically underserved AA women. Methods AA women recommended for GC based on cancer genetic risk assessment performed in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in GC and intervention satisfaction. Results Pilot recruitment goals were met (n=30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a GC appointment, compared with 70% post-intervention (p=0.0001). After watching the intervention, 50% of participants indicated that the video changed their mind regarding GC. Conclusions This study demonstrated cultural acceptability of a decision aid intervention designed to motivate AA women with hereditary breast cancer risk to attend a GC appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study.

The relevance of Chemistry in Tumor microenvironment of Cancer Patient

The prime mechanisms for the alteration or reshaping of common somatic gene cells into malignant tumor gene cells are transgenic or oncogene activation and tumor-suppresser gene cell dismission. Cancer genetic cells are the propulsion of growing and expansion. On the other side, they are incapable of developing them self. The wen microhabitat is thought of plays an extra energetic role in Wen improvement than merely existing as a bystander. Wen Cells dexterously enroll connective tissue cells. Through several walkways, which then supply Wen Cells with improved Signs, median metabolites, and a favorable environment for tumor expansion and metastasis. Lymphoma or tumor cells and the microhabitat environment work both will promote large expansion and metathetical potential through mutual communication. Understanding the play of the wen or tumor sensitive small environment in Wen Expansion can direct to new routes to target the Wen Small environment for more efficient anti-tumor medications or cures. In this study, we address the methods involved in Wen or tumor cells enrolling connective cells to the prime tumor place. Along with that it also explained and highlighted the small microhabitats environment and tumor development process. We also mentioned some of the possible potential treatment approaches of cancer treatment which can mighty be helpful for better results.

Exploring the Performance of Ultrasound Risk Stratification Systems in Thyroid Nodules of Pediatric Patients

Neck ultrasound (nUS) is the cornerstone of clinical management of thyroid nodules in pediatric patients, as well as adults. The current study was carried out to explore and compare the diagnostic performance of the main US-based risk stratification systems (RSSs) (i.e., the American College of Radiology (ACR), European (EU), Korean (K) TI-RADSs and ATA US RSS criteria) for detecting malignant thyroid lesions in pediatric patients. We conducted a retrospective analysis of consecutive children and adolescents who received a diagnosis of thyroid nodule. We included subjects with age <19 years having thyroid nodules with benign cytology/histology or final histological diagnosis. We excluded subjects with (a) a previous malignancy, (b) a history of radiation exposure, (c) cancer genetic susceptibility syndromes, (d) lymph nodes suspicious for metastases of thyroid cancer at nUS, (e) a family history of thyroid cancer, or (f) cytologically indeterminate nodules without histology and nodules with inadequate cytology. We included 41 nodules in 36 patients with median age 15 years (11–17 years). Of the 41 thyroid nodules, 29 (70.7%) were benign and 12 (29.3%) were malignant. For both ACR TI-RADS and EU-TIRADS, we found a sensitivity of 41.7%. Instead, for both K-TIRADS and ATA US RSS, we found a sensitivity of 50%. The missed malignancy rate for ACR-TIRADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 50%. The unnecessary FNA prevalence for ACR TI-RADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 76%. Our findings suggest that the four US-based RSSs (i.e., ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA US RSS) have suboptimal performance in managing pediatric patients with thyroid nodules, with one-half of cancers without indication for FNA according to their recommendations.

Factors Influencing Patient Preferences for Telehealth Cancer Genetic Counseling During the COVID-19 Pandemic

PURPOSE: With onset of the COVID-19 pandemic, telehealth became the primary modality for health care appointments. This study examined patient experiences with and preferences for telehealth at a cancer genetic counseling clinic throughout the first 6 months of the pandemic (March-August 2020). METHODS: An anonymous survey assessed patient demographics; usage and prior experience with technology; emotional responses, technical experiences, and satisfaction with the telehealth appointment (via the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire); preference for future telehealth; and recommendation of telehealth to others. RESULTS: Among 380 respondents, most were highly satisfied with the telehealth appointment (with 65.6% and 66.4% of participants completing the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire, respectively). Multivariable analyses indicated several notable findings. Adjusting for relevant covariates, participants with less education felt significantly more concerned about telehealth than those with highest educational attainment. Participants age 40-69 years were generally more comfortable, relieved, and grateful that their appointment was scheduled as telehealth than were those older than 70 years. Women were marginally more relieved and grateful for telehealth appointments than men. As the pandemic progressed, significantly more participants were highly satisfied with their telehealth appointment and participants trended toward having greater preferences for future telehealth use. Most participants (78.6%) would recommend telehealth to others, although 50.8% preferred future in-person appointments. CONCLUSION: As the pandemic progressed, patients expressed increasing preferences for and satisfaction with telehealth. Service delivery models that incorporate individual patient preferences should be developed with special consideration to factors such as age, sex, and education level.