Skip to main content
Top
Published in: Journal of Genetic Counseling 2/2014

01-04-2014 | Original Research

Identifying Outcomes of Clinical Genetic Services: Qualitative Evidence and Methodological Considerations

Author: Christalla Pithara

Published in: Journal of Genetic Counseling | Issue 2/2014

Login to get access

Abstract

Extensive research into the tangible and intangible implications of Clinical Genetic Services (CGSs) has confirmed the relevance of a multidimensional outcome of benefit conceptually linked to perceived control. This paper aims to report qualitative findings from one small study aiming to add to the evidence pool confirming the relevance of such an outcome to participants from one UK clinical genetics center. Data were collected using focus groups and individual interviews with 22 service users from the following conditions: Hereditary Breast and Ovarian Cancer (HBOC), von Hippel Lindau disorder (VHL), Duchenne and Becker muscular dystrophy (DBMD), cystic fibrosis (CF) and tuberous sclerosis (TS). Transcripts were analyzed using thematic analysis and four dimensions of benefit were identified relating to cognitive, behavioral, social and emotional consequences. These dimensions related to an overarching conceptual outcome described as Perceived Familial Control. Findings are discussed to illustrate the inter-generational and intra-generational familial dimensions of CGSs and reinforce the significance of a familial focus to any genetics-specific outcome measure. The prospect and methodological considerations of a familial composite outcome measure for measuring overall benefit of CGSs is discussed based on current and past findings.
Appendix
Available only for authorised users
Literature
go back to reference Biesecker, B. B., & Peters, K. F. (2001). Process studies in genetic counseling: peering into the black box. American Journal of Medical Genetics, 106(3), 191–198.PubMedCrossRef Biesecker, B. B., & Peters, K. F. (2001). Process studies in genetic counseling: peering into the black box. American Journal of Medical Genetics, 106(3), 191–198.PubMedCrossRef
go back to reference Brain, K., Gray, J., Norman, P., Parsons, E., Clarke, A., Rogers, C., et al. (2000). Why do women attend familial breast cancer clinics? Journal of Medical Genetics, 37(3), 197–202.PubMedCentralPubMedCrossRef Brain, K., Gray, J., Norman, P., Parsons, E., Clarke, A., Rogers, C., et al. (2000). Why do women attend familial breast cancer clinics? Journal of Medical Genetics, 37(3), 197–202.PubMedCentralPubMedCrossRef
go back to reference Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77.CrossRef Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77.CrossRef
go back to reference Chang, S., Newton, P. J., Inglis, S., Luckett, T., Krum, H., Macdonald, P., et al. (2012). Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment. Heart Failure Reviews, 1–10. doi:10.1007/s10741-012-9369-0. Chang, S., Newton, P. J., Inglis, S., Luckett, T., Krum, H., Macdonald, P., et al. (2012). Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment. Heart Failure Reviews, 1–10. doi:10.​1007/​s10741-012-9369-0.
go back to reference Cohen, D., Barton, G., & Brain, K. (2004). Health economics and genetic service development: a familial cancer genetic example. Familial Cancer, 3, 61–67.PubMedCrossRef Cohen, D., Barton, G., & Brain, K. (2004). Health economics and genetic service development: a familial cancer genetic example. Familial Cancer, 3, 61–67.PubMedCrossRef
go back to reference Cordoba, G., Schwartz, L., Woloshin, S., Bae, H., & Gøtzsche, P. C. (2010). Definition, reporting, and interpretation of composite outcomes in clinical trials: systematic review. BMJ, 341. Cordoba, G., Schwartz, L., Woloshin, S., Bae, H., & Gøtzsche, P. C. (2010). Definition, reporting, and interpretation of composite outcomes in clinical trials: systematic review. BMJ, 341.
go back to reference Davey, A., Rostant, K., Harrop, K., Goldblatt, J., & O’Leary, P. (2005). Evaluating genetic counseling: client expectations, psychological adjustment and satisfaction with service. Journal of Genetic Counseling, 14(3), 197–206.PubMedCrossRef Davey, A., Rostant, K., Harrop, K., Goldblatt, J., & O’Leary, P. (2005). Evaluating genetic counseling: client expectations, psychological adjustment and satisfaction with service. Journal of Genetic Counseling, 14(3), 197–206.PubMedCrossRef
go back to reference Department of Health. (2010). Specialised services national definitions set: Medical genetic services (all ages) No.20 (3rd Edition): Department of Health, UK. Department of Health. (2010). Specialised services national definitions set: Medical genetic services (all ages) No.20 (3rd Edition): Department of Health, UK.
go back to reference Ferreira-González, I., Permanyer-Miralda, G., Busse, J. W., Bryant, D. M., Montori, V. M., Alonso-Coello, P., et al. (2007). Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns. Journal of Clinical Epidemiology, 60(7), 651–657.PubMedCrossRef Ferreira-González, I., Permanyer-Miralda, G., Busse, J. W., Bryant, D. M., Montori, V. M., Alonso-Coello, P., et al. (2007). Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns. Journal of Clinical Epidemiology, 60(7), 651–657.PubMedCrossRef
go back to reference Godard, B., Kaariainen, H., Kristoffersson, U., Tranebjaerg, L., Coviello, D., & Ayme, S. (2003). Provision of genetic services in Europe: current practices and issues. European Journal of Human Genetics, 11(Suppl 2), S13–S48.PubMedCrossRef Godard, B., Kaariainen, H., Kristoffersson, U., Tranebjaerg, L., Coviello, D., & Ayme, S. (2003). Provision of genetic services in Europe: current practices and issues. European Journal of Human Genetics, 11(Suppl 2), S13–S48.PubMedCrossRef
go back to reference Hughes, H. E., Alderman, J. K., Krawczak, M., & Rogers, C. (1998). Contracting for clinical genetic services: the Welsh model. Journal of Medical Genetics, 35(4), 309–313.PubMedCentralPubMedCrossRef Hughes, H. E., Alderman, J. K., Krawczak, M., & Rogers, C. (1998). Contracting for clinical genetic services: the Welsh model. Journal of Medical Genetics, 35(4), 309–313.PubMedCentralPubMedCrossRef
go back to reference Mayo, N. E., & Scott, S. (2011). Evaluating a complex intervention with a single outcome may not be a good idea: an example from a randomised trial of stroke case management. Age and Ageing, 40(6), 718–724.PubMedCrossRef Mayo, N. E., & Scott, S. (2011). Evaluating a complex intervention with a single outcome may not be a good idea: an example from a randomised trial of stroke case management. Age and Ageing, 40(6), 718–724.PubMedCrossRef
go back to reference McAllister, M., Payne, K., MacLeod, R., Nicholls, S., Donnai, D., & Davies, L. (2008a). Patient empowerment in clinical genetics services. Journal of Health Psychology, 13(7), 895–905.PubMedCrossRef McAllister, M., Payne, K., MacLeod, R., Nicholls, S., Donnai, D., & Davies, L. (2008a). Patient empowerment in clinical genetics services. Journal of Health Psychology, 13(7), 895–905.PubMedCrossRef
go back to reference McAllister, M., Payne, K., MacLeod, R., Nicholls, S., Donnai, D., & Davies, L. M. (2008b). What process attributes of clinical genetics services could maximise patient benefits? European Journal of Human Genetics, 16(12), 1467–1476.PubMedCrossRef McAllister, M., Payne, K., MacLeod, R., Nicholls, S., Donnai, D., & Davies, L. M. (2008b). What process attributes of clinical genetics services could maximise patient benefits? European Journal of Human Genetics, 16(12), 1467–1476.PubMedCrossRef
go back to reference McAllister, M., Dunn, G., & Todd, C. (2011a). Empowerment: qualitative underpinning of a new clinical genetics-specific patient-reported outcome. European Journal of Human Genetics, 19(2), 125–130.PubMedCentralPubMedCrossRef McAllister, M., Dunn, G., & Todd, C. (2011a). Empowerment: qualitative underpinning of a new clinical genetics-specific patient-reported outcome. European Journal of Human Genetics, 19(2), 125–130.PubMedCentralPubMedCrossRef
go back to reference McAllister, M., Wood, A., Dunn, G., Shiloh, S., & Todd, C. (2011b). The Genetic Counseling Outcome Scale: a new patient-reported outcome measure for clinical genetics services. Clinical Genetics, 79(5), 413–424.PubMedCrossRef McAllister, M., Wood, A., Dunn, G., Shiloh, S., & Todd, C. (2011b). The Genetic Counseling Outcome Scale: a new patient-reported outcome measure for clinical genetics services. Clinical Genetics, 79(5), 413–424.PubMedCrossRef
go back to reference McAllister, M., Wood, A. M., Dunn, G., Shiloh, S., & Todd, C. (2012). The perceived personal control (PPC) questionnaire: reliability and validity in a sample from the United Kingdom. American Journal of Medical Genetics. Part A, 158A(2), 367–372.PubMedCrossRef McAllister, M., Wood, A. M., Dunn, G., Shiloh, S., & Todd, C. (2012). The perceived personal control (PPC) questionnaire: reliability and validity in a sample from the United Kingdom. American Journal of Medical Genetics. Part A, 158A(2), 367–372.PubMedCrossRef
go back to reference Payne, K., Nicholls, S. G., McAllister, M., Macleod, R., Ellis, I., Donnai, D., et al. (2007). Outcome measures for clinical genetics services: a comparison of genetics healthcare professionals and patients’ views. Health Policy, 84(1), 112–122.PubMedCrossRef Payne, K., Nicholls, S. G., McAllister, M., Macleod, R., Ellis, I., Donnai, D., et al. (2007). Outcome measures for clinical genetics services: a comparison of genetics healthcare professionals and patients’ views. Health Policy, 84(1), 112–122.PubMedCrossRef
go back to reference Payne, K., Nicholls, S., McAllister, M., MacLeod, R., Donnai, D., & Davies, L. M. (2008). Outcome measurement in clinical genetics services: a systematic review of validated measures. Value in Health, 11(3), 497–508.PubMedCrossRef Payne, K., Nicholls, S., McAllister, M., MacLeod, R., Donnai, D., & Davies, L. M. (2008). Outcome measurement in clinical genetics services: a systematic review of validated measures. Value in Health, 11(3), 497–508.PubMedCrossRef
go back to reference Pithara, C. (2011). Identifying the benefits and disbenefits of Clinical Genetic Services: A framework for economic evaluation. Unpublished PhD thesis, University of Glamorgan, Wales (UK), Treforest. Pithara, C. (2011). Identifying the benefits and disbenefits of Clinical Genetic Services: A framework for economic evaluation. Unpublished PhD thesis, University of Glamorgan, Wales (UK), Treforest.
go back to reference Pope, C., & Mays, N. (Eds.). (2006). Qualitative research in health care (3rd ed.) Blackwell Publishing, Malden, MA. Pope, C., & Mays, N. (Eds.). (2006). Qualitative research in health care (3rd ed.) Blackwell Publishing, Malden, MA.
go back to reference Schlich-Bakker, K. J., ten Kroode, H. F., Warlam-Rodenhuis, C. C., van den Bout, J., & Ausems, M. G. (2007). Barriers to participating in genetic counseling and BRCA testing during primary treatment for breast cancer. Genetics in Medicine, 9(11), 766–777.PubMedCrossRef Schlich-Bakker, K. J., ten Kroode, H. F., Warlam-Rodenhuis, C. C., van den Bout, J., & Ausems, M. G. (2007). Barriers to participating in genetic counseling and BRCA testing during primary treatment for breast cancer. Genetics in Medicine, 9(11), 766–777.PubMedCrossRef
go back to reference Smerecnik, C., Mesters, I., Verweij, E., de Vries, N., & de Vries, H. (2009). A systematic review of the impact of genetic counseling on risk perception accuracy. Journal of Genetic Counseling, 18(3), 217–228.PubMedCrossRef Smerecnik, C., Mesters, I., Verweij, E., de Vries, N., & de Vries, H. (2009). A systematic review of the impact of genetic counseling on risk perception accuracy. Journal of Genetic Counseling, 18(3), 217–228.PubMedCrossRef
go back to reference The Physician Consortium for Performance Improvement. (2010). Measures Development, Methodology, and Oversight Advisory Committee: Recommendations to PCPI Work Groups on Composite Measures: American Medical Association. The Physician Consortium for Performance Improvement. (2010). Measures Development, Methodology, and Oversight Advisory Committee: Recommendations to PCPI Work Groups on Composite Measures: American Medical Association.
go back to reference Wang, C., Gonzalez, R., & Merajver, S. D. (2004). Assessment of genetic testing and related counseling services: current research and future directions. Social Science & Medicine, 58(7), 1427–1442.CrossRef Wang, C., Gonzalez, R., & Merajver, S. D. (2004). Assessment of genetic testing and related counseling services: current research and future directions. Social Science & Medicine, 58(7), 1427–1442.CrossRef
Metadata
Title
Identifying Outcomes of Clinical Genetic Services: Qualitative Evidence and Methodological Considerations
Author
Christalla Pithara
Publication date
01-04-2014
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 2/2014
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-013-9654-7

Other articles of this Issue 2/2014

Journal of Genetic Counseling 2/2014 Go to the issue