RESUMO
BACKGROUND: Accurate variant classification and relaying reclassified results to patients is critical for hereditary cancer care delivery. Over a 5- to 10-year period, 6%-15% of variants undergo reclassification. As the frequency of reclassifications increases, the issue of whether, how, when, and which providers should recontact patients becomes important but remains contentious. METHODS: The authors used inductive thematic analysis to analyze open-ended comments offered by oncologists and genetic counselors (GCs) from a large national survey. RESULTS: Of the 634 oncologists and cancer GCs, 126 (20%) offered substantive free-text comments. Four thematic areas emerged: 1) ambiguity over professional responsibility to recontact, 2) logistical challenges with recontact, 3) importance of inter-institutional communication, and 4) suggested solutions. Some oncologists felt that laboratories, not them, are responsible for recontact; others believed that ordering providers/GCs were responsible; GCs readily acknowledged their own responsibility in recontact but added important caveats. Besides the lack of up-to-date patient contact information, providers raised unique challenges with recontact: financial instability of laboratories, lack of clinical resources, contacting family members, and accumulating burden of reclassifications. There were numerous calls for developing practice guidelines on prioritizing variants for recontact and discussion on whether duty for recontact may be fulfilled via unidirectional, low touch modalities. Potential solutions to recontact including national databases and patient facing databases were discussed. CONCLUSIONS: The authors confirm previous themes of stakeholder opinions and add previously unreported contextual details to qualify those themes. Clarifying provider responsibilities through professional guidelines for reclassification and recontact addressing the subthemes identified here will better serve all constituencies.
RESUMO
BACKGROUND: The US has seen an increase in the popularity of highly concentrated forms of cannabis (hereafter concentrates) and too little is known about the potential risks associated with their use. OBJECTIVES: The present study aims to better understand the patterns and outcomes of concentrates use through the perspectives of young adult users. METHODS: Participants (N = 234, 27.9% female) aged 18-35 years were recruited using SurveyMonkey Audience® and had ingested concentrates at least once in the past 6 months. They were queried on concentrates use patterns (e.g., frequency, medical/recreational) and the effects experienced after using concentrates (e.g., physiological/psychological, strength/duration). RESULTS: A total of 27.8% of participants reported frequent use of concentrates (≥10 days in past month). Those who used for medical purposes or lived in states where use is legal were more likely to use concentrates frequently. While most (64.2%) did not report experiencing potentially serious side effects, some reported a sense of altered reality/confusion (23.3%), rapid heartbeat (11.2%), lung pain (9.9%) and severe paranoia (6.9%). Among those who used concentrates in the past month (N = 168), 72.6% used concentrates with other cannabis forms, 57.7% used along with alcohol, and 22.6% used with other drugs. CONCLUSION: Continued research on concentrates use in the US is needed. Research-informed policies that foster safe and responsible use of concentrates are necessary to protect users, especially those who use concentrates frequently, from potential negative side effects.