Outcomes from a pilot genetic counseling intervention using motivational interviewing and the extended parallel process model to increase cascade cholesterol screening

Baldry, Emma; Redlinger‐Grosse, Krista; MacFarlane, Ian M.; Walters, Scott T.; Ash, Erin; Steinberger, Julia; Murdy, Kari A.; Cragun, Deborah; Allen-Tice, Carly; Zierhut, Heather

doi:10.1002/jgc4.1466

Cited by 8 publications

(5 citation statements)

References 60 publications

(66 reference statements)

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“…The two positive probands gave 4 relatives information and subsequently underwent genetic testing with two having positive results [49]. Motivational interviewing and the extended parallel process model with probands has been tested as an intervention to improve cascade screening and found on average 2.23 new relatives were contacted and 2.46 were screened [50]. A feasibility study based on core principles from the Dutch model, found that when the FH Foundation served as the agency to directly engage with 11 FH probands, they were able to engage nine relatives [51].…”

Section: Resultsmentioning

confidence: 99%

Applying implementation science to improve care for familial hypercholesterolemia

Jones¹,

Brownson

Williams³

2021

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewImproving care of individuals with familial hypercholesteremia (FH) is reliant on the synthesis of evidence-based guidelines and their subsequent implementation into clinical care. This review describes implementation strategies, defined as methods to improve translation of evidence into FH care, that have been mapped to strategies from the Expert Recommendations for Implementing Change (ERIC) compilation.Recent findingsA search using the term ‘familial hypercholesterolemia’ returned 1350 articles from November 2018 to July 2021. Among these, there were 153 articles related to improving FH care; 1156 were excluded and the remaining 37 were mapped to the ERIC compilation of strategies: assess for readiness and identify barriers and facilitators [9], develop and organize quality monitoring systems [14], create new clinical teams [2], facilitate relay of clinical data to providers [4], and involve patients and family members [8]. There were only 8 of 37 studies that utilized an implementation science theory, model, or framework and two that explicitly addressed health disparities or equity.SummaryThe mapping of the studies to implementation strategies from the ERIC compilation provides a framework for organizing current strategies to improve FH care. This study identifies potential areas for the development of implementation strategies to target unaddressed aspects of FH care.

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Section: Resultsmentioning

confidence: 99%

Applying implementation science to improve care for familial hypercholesterolemia

Jones¹,

Brownson

Williams³

2021

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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“…Second, communications from clinicians applying these recommendations from individuals and families with FH should be tested in prospective trials. A recent pilot intervention incorporating motivational interviewing and the EPPM in genetic counseling with parents of a child with FH demonstrated increased disclosure and cascade testing rates among at-risk relatives [ 44 ]. Findings from the current study complement this pilot genetic counseling intervention by providing examples of message features future interventions can incorporate to communicate about FH risk and motivate cascade testing uptake.…”

Section: Discussionmentioning

confidence: 99%

Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication

Campbell‐Salome

Walters²,

Ladd³

et al. 2022

Translational Behavioral Medicine

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Motivating at-risk relatives to undergo cascade testing for familial hypercholesterolemia (FH) is critical for diagnosis and lifesaving treatment. As credible sources of information, clinicians can assist in family communication about FH and motivate cascade testing uptake. However, there are no guidelines regarding how clinicians should effectively communicate with probands (the first person diagnosed in the family) and at-risk relatives. Individuals and families with FH can inform our understanding of the most effective communications to promote cascade testing. Guided by the extended parallel process model (EPPM), we analyzed the perspectives of individuals and families with FH for effective messaging clinicians can use to promote cascade testing uptake. We analyzed narrative data from interviews and surveys collected as part of a larger mixed-methods study. The EPPM was used to identify message features recommended by individuals and families with FH that focus on four key constructs (severity, susceptibility, response efficacy, self-efficacy) to promote cascade testing. Participants included 22 individuals from 11 dyadic interviews and 98 survey respondents. Participants described prioritizing multiple messages that address each EPPM construct to alert relatives about their risk. They illustrated strategies clinicians could use within each EPPM construct to communicate to at-risk relatives about the importance of pursuing diagnosis via cascade testing and subsequent treatment for high cholesterol due to FH. Findings provide guidance on effective messaging to motivate cascade testing uptake for FH and demonstrates how the EPPM may guide communication with at-risk relatives about genetic risk and motivate cascade testing broadly.

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“…Post‐intervention surveys for this study included the modified RBD scale, the Informing Relatives Inventory, and information on risk communication and screening of relatives. Detailed analysis of the pre‐ and post‐intervention survey data was done in a separate CHEERS analysis (Baldry et al., 2021).…”

Section: Methodsmentioning

confidence: 99%

Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia

Winchester

Cragun

Redlinger‐Grosse

et al. 2022

Journal of Genetic Counseling

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Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcomes within families with familial hypercholesterolemia, a common, underdiagnosed, and treatable condition. Parents of children with familial hypercholesterolemia were invited to participate in an online pre-survey, singlesession genetic counseling intervention, and post-intervention surveys as a part of the CHEERS (Cholesterol Evaluation to Explore Risk Screening) intervention. This study investigated the efficacy of a genetic counselor delivered motivational interviewing intervention and how parents of children with familial hypercholesterolemia react by assessing family member cholesterol screening and risk communication to at-risk relatives. Transcripts were audio-recorded, transcribed, and analyzed for change talk using the Motivational Interviewing Skill Code version 2.1. Participant surveys were analyzed for self-reported extended parallel process constructs and motivations.Coincidence analysis was conducted to explore differences between those with and without positive cascade outcomes within 12 months after the intervention. On average, change talk increased during the session in order of the extended parallel process constructs (perceived severity, susceptibility, response efficacy, self-efficacy).Coincidence analysis revealed that 6 of the 7 cases with positive cascade outcomes were explained by either the presence of high change talk during the intervention or presence of positive motivations shortly after, while 5 of the 5 cases without a positive outcome lacked both of these key factors that were associated with cascade outcomes. Results of this study suggest that incorporating motivational interviewing and the extended parallel process model increases change talk and that the presence of either high levels of change talk or positive motivations is associated with positive cascade outcomes.

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Outcomes from a pilot genetic counseling intervention using motivational interviewing and the extended parallel process model to increase cascade cholesterol screening

Cited by 8 publications

References 60 publications

Applying implementation science to improve care for familial hypercholesterolemia

Applying implementation science to improve care for familial hypercholesterolemia

Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication

Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia

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