Genetic testing for hereditary breast and ovarian cancer is increasingly being offered in newly diagnosed breast and ovarian cancer patients. This genetic information may influence treatment decisions. However, there are some concerns that genetic testing offered in an already vulnerable situation might be an extra burden to these women. The aim of this study was to explore the experiences of women who had been offered and accepted genetic testing when newly diagnosed with breast or ovarian cancer. Four semi-structured focus-group interviews were conducted with 17 women recruited from a Norwegian multicenter study. The material was condensed, and conventional qualitative analysis was used to identify patterns in the participants’ descriptions. Three core themes were identified: 1) being “beside oneself” 2) altruism and ethical dilemmas 3) the need for support and counselling to assist the decision process. The present study indicates that women who are offered genetic testing when newly diagnosed with breast or ovarian cancer want a consultation with a health professional. Personalized support and counselling might empower women to improve their ability to manage and comprehend this overwhelming situation, and find meaning in this experience.
Aim The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care. Design Systematic review. Data Sources MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer‐reviewed papers. No language, geographical or publication date restrictions. Review Methods Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk‐of‐bias tool. Results In total, 10,524 references were identified in the literature search, twenty‐six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre‐discharge; (ii). establishment of contact with the local healthcare services pre‐discharge and (iii). follow‐up initiated by nurses from the hospital at home post‐discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa. Conclusion Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match. Impact This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.
BACKGROUND Genetic testing has become an integrated part of the health care for patients with breast or ovarian cancer, and the increasing demand of genetic testing is accompanied by an increasing need of easy access to reliable genetic information for patients. We therefore developed an app (named Rosa), a virtual assistant able to perform human-like digital conversations about genetic BRCA-testing, using chatbot technology. OBJECTIVE Before implementing this new information service in daily clinical practice, we wanted to explore two aspects of chatbot use: 1) The perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer, and 2) How interaction with a chatbot regarding sensitive information about hereditary cancer, influences the patients. METHODS A total of 175 healthy individuals at risk of hereditary breast and ovarian cancer, were invited to test the chatbot Rosa before and after genetic counseling. Among 61 participants that consented for individual interview, a selected subgroup of 16 subjects shared their experience through in-depth interviews over video. To secure a varied sample, the participants were recruited from all cancer genetic clinics in Norway and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. RESULTS The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability, and that they could have access wherever they were. The fact that Rosa was created by health care professionals made them feel safe that they received medically correct information. It was referred to as an alternative to Google, only better, since it provided specific and reliable answers to their questions. All participants denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. CONCLUSIONS This study shows that chatbot use in clinical genetic practice contributes to uniform information for our patients, regardless of residence and access to specialized healthcare personnel, without adding discomfort or worry. The availability of quality assured information, tailored to the specific situation the patient is facing, has had a reassuring effect on the participants. This indicates that a chatbot can be a well-suited companion to genetic counseling, however we found no evidence supporting that Rosa could replace genetic counseling.
Background Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: “Anytime, anywhere”; “In addition, not instead”; and “Trustworthy and true.” All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling.
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