Professional Challenges in Cancer Genetic Testing: Who Is the Patient?

In the genetic counseling setting, the health care provider can be challenged by opposing duties to members of the same family: protecting the privacy of the patient identified with a gene mutation and the ethical obligation to warn at‐risk relatives. In a situation of nondisclosure between members...

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Bibliographic Details
Published in:The oncologist (Dayton, Ohio) Ohio), 2008-03, Vol.13 (3), p.232-238
Main Authors: Chan‐Smutko, Gayun, Patel, Devanshi, Shannon, Kristen M., Ryan, Paula D.
Format: Article
Language:English
Subjects:
Adult
Breast Neoplasms - genetics
Breast Neoplasms - prevention & control
Colorectal Neoplasms, Hereditary Nonpolyposis - genetics
Colorectal Neoplasms, Hereditary Nonpolyposis - prevention & control
Communication
Confidentiality
Conflict (Psychology)
DNA-Binding Proteins - genetics
Duty to Warn
Family dynamics
Female
Founder Effect
Genes, BRCA1
Genetic Counseling
Genetic Predisposition to Disease
Genetic Testing
Humans
Jews
Mutation
Neoplasms - diagnosis
Neoplasms - genetics
Neoplasms - prevention & control
Ovarian Neoplasms - genetics
Ovarian Neoplasms - prevention & control
Patient confidentiality
Pedigree
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Summary:In the genetic counseling setting, the health care provider can be challenged by opposing duties to members of the same family: protecting the privacy of the patient identified with a gene mutation and the ethical obligation to warn at‐risk relatives. In a situation of nondisclosure between members of a family with a known disease‐predisposing mutation, this type of dilemma can present in acute form for the provider who cares for different members of the family. This can hinder effective medical decision making. To minimize this effect, we recommend detailed pretest genetic counseling steps to empower the patient to communicate with their at‐risk relatives their intent to pursue testing and willingness to share information. In addition, post‐test counseling should reiterate the implications of a positive result for at‐risk relatives and conclude with a written summary that patients can share with their family. Two cases are presented to illustrate a number of professional and ethical conflicts for providers regarding cancer genetic testing. The authors recommend detailed pretest genetic counseling steps to empower the patient to communicate with their at‐risk relatives and post‐test counseling to reiterate the implications of a positive result for at‐risk relatives.
ISSN:1083-7159
1549-490X
DOI:10.1634/theoncologist.2007-0203