116 relatives of lung cancer patients were recruited. First- or second-degree blood relatives who are current smokers between the ages 18 to 55 were eligible for the study. a web-based research protocol will be employed because relatives lived throughout the United States. A recruiter approached patients at Moffitt Cancer Center in Tampa FL and assessed their willingness to do a telephone survey to enumerate the number of their relatives who smoke and determine if they would give permission to contact none, some, or all of these relatives. The recruitment for this study was conducted in partnership with ongoing recruitment activities for a five-year, NCI-funded randomized controlled intervention trial at Duke University Medical Center. As part of the educational session, participants were offered free genetic susceptibility testing for glutathione S transferase. Participants who accepted testing received their result online. ? ? Participants who declined testing were retained in the study and offered all the same smoking cessation services. Survey assessments included questions about risk perceptions, beliefs and attitudes related to lung cancer, emotional responses to the patients diagnosis, smoking history, motivation to quit, reactions to information about smoking and genetic risk, interest in genetic testing, comprehension of susceptibility feedback, and interest in receiving smoking cessation services. The primary outcome variable was seeking free smoking cessation services. All data collection for the project is now completed. 58 of the 116 relatives logged on to the website, of whom 44 requested genetic testing. 22 of the 44 received high risk results and 22 received low risk results. A total of 73 completed the six-month follow-up survey. ? ? Our baseline data on a relatively large sample of relatives (N=296) affords the serendipitous opportunity to address several questions that have been raised in the literature related to offering genetic susceptibility testing to large populations. We have conducted preliminary analyses on two of these concerns. The first relates to the external validity of using interest in hypothetical testing scenarios to infer uptake rates of genetic susceptibility testing for common health conditions.4 The second relates to concerns raised that smokers might be motivated to find out they are at lower risk so as to justify continued smoking. Both of these concerns speak to the feasibility of offering genetic susceptibility testing to large populations when person-to-person contact may not be available. ? ? To address the first question, all individuals who completed the baseline survey were asked to indicate their interest in a vaguely described hypothetical genetic susceptibility test for lung cancer; 61% indicated that they most probably would be tested. We are among the few to have data that enables us to explore the congruence between hypothetical interest and actual behavior as well as factors that might predict greater congruence between the two. Our results show that hypothetical interest was a poor predictor of logging on to the website to consider testing or for being tested. Individuals were better able to predict what they would do with respect to logging on and being testing when they had prior awareness of genetic testing. Individuals were less able to predict their behavior when they believed that lung cancer runs families. This is particularly concerning as we move from using hypothetical vignettes with high risk populations to use in the general public where experience with and beliefs about genetics will be variable. ? ? Our preliminary analyses related to the second question suggest that believing the test would be motivational for encouraging smoking cessation was the leading predictor of interest in the hypothetical test. There was no support and only a minority endorsed the belief that being tested could justify continued smoking. ? ? Informed decision-making and cessation-related outcomes: The web-based decision approach facilitated informed decisions. Based on Marteaus multidimensional conceptualization of informed decision-making, 48% arrived at an informed decision about testing. This compares reasonably well with other clinician-guided decision support approaches. These analyses also suggest that relatives who were more distant from the patient appeared to benefit most from web-based decision support modalities, whereas those who were closest and in turn, most emotionally affected by the patients diagnosis benefited from additional interpersonal support. This manuscript is currently under review with Genetics in Medicine.? ? Other analyses showed that participants who availed themselves of the web-site and sought testing all were able to recall and comprehend their test results with high accuracy, that is, be able to recall the test result and its meaning. Moreover, there was no evidence of biased information processing as indicated by tracking of engagement with the information presented on the website (e.g., time spent on strengths and weaknesses of the test). Also in contrast to our previous research in a primary care setting, it appears that receiving high risk genetic susceptibility results in this context was associated with an almost five-fold increase in self-reported smoking cessation at six month follow-up. Clearly, these results must be replicated in a larger and controlled trial.? ? Taken together, genetic susceptibility testing provided via a web-based modality appears to be feasible and appropriate for some, but perhaps not all, smokers. Provision of feedback that one is genetically susceptible to lung cancer in the context of a blood relatives diagnosis of lung cancer along with a self-directed smoking cessation intervention could be beneficial for promoting smoking cessation. However, the challenge remains to convey nonsusceptibility in ways the sustain motivation to quit smoking.
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