Focusing on patient needs and preferences may improve genetic counseling for colorectal cancer.

During cancer genetic counseling, different items which counselors consider important are discussed. However, relatively little empirical evidence exists regarding the needs and preferences of counselees. In this study needs and preferences were assessed from counselees with a personal and/or family history of colorectal cancer (CRC), who were referred for genetic counseling regarding CRC. They received a slightly modified version of the QUOTE-GENE(ca) questionnaire prior to their first visit to the Hereditary Cancer Clinic. Response rate was 60 % (48/80 participants). Counselees rated the importance of 45 items assessing their needs and preferences regarding the content and process of genetic counseling. Participants rated the items regarding discussion of information about their familial CRC risk (100 %) and preventive options (98 %) as important or very important. Fewer participants rated items concerning general information on genetics as important. Sensitive communication during counseling was considered very important by a large percentage of counselees. Generally, no major differences were seen between participants in relation to individual characteristics. Our data suggest that focusing on familial CRC risk and surveillance options, in combination with sensitive communication may lead to better satisfaction with genetic counseling.

Acceptance of genetic counseling and testing in a hospital-based series of patients with gynecological cancer.

Referral of patients with endometrial (EC) and/or ovarian cancer (OC) for genetic counseling is based on age at diagnosis and family history. Many patients with hereditary cancers are missed by following this strategy. We determined acceptance and mutation detection rate of offering genetic counseling and testing to unselected EC and OC patients. Therefore, in 2007, EC and OC patients were invited for genetic counseling and testing. Patients were asked for their reasons to accept or decline. Nineteen out of fifty-two EC patients (36 %) and twenty-two out of thirty-five OC patients (63 %) accepted genetic counseling, mainly to receive risk assessment for themselves and relatives. Counseling was declined mainly because patients did not want more tests or had no relatives for whom it was relevant. Eighteen out of nineteen EC patients (95 %) and twenty out of twenty-two OC patients (91 %) underwent genetic testing. One EC patient carried an MSH6 mutation (mutation detection rate: 6 %). BRCA1/2 mutations were found in two out of twenty OC patients (10 %). Eleven patients (29 %) received surveillance recommendations for themselves and their relatives. Finally, family history recorded by the gynecologist was compared to that taken by the clinical geneticist. Gynecologists reported family history in ten out of forty-one participants (24 %). In conclusion, genetic counseling and testing are acceptable to patients with OC and/or EC. The 10 % BRCA1/2 mutation detection rate and underreporting of family history by gynecologists warrant referral for genetic counseling for all OC patients, followed by BRCA1/2 testing if indicated. We recommend that microsatellite instability and immunohistochemical analysis be performed in all EC patients, followed by genetic counseling if appropriate. These strategies will lead to better cancer prevention in gynecological cancer patients and their relatives.

Effect of the new Bologna bachelor degree on career considerations of medical students in one medical school.

BACKGROUND: The bachelor-master (BaMa) structure was introduced in medical schools in The Netherlands since 2003 and in Utrecht University in 2006. AIM: The aim of this study was to determine whether conferring a bachelor degree at the end of 3 years of medical school influences the career considerations of the students. METHODS: Two cohorts (BaMa and pre-BaMa) of medical students at Utrecht University were approached to fill out questionnaires in 2008 and 2009, about their career plans and whether a bachelor degree would affect these plans. RESULTS: In 2008, two-thirds of the students in both cohorts indicated that they considered a temporary stop. In 2009, the BaMa cohort showed substantially less interest in such a stop than the pre-BaMa cohort. Very few students considered a permanent stop. Comparison of third year pre-BaMa students (2008 cohort) with third year BaMa students (2009 cohort) revealed adjusted odds ratios of 2.34 (95% CI 1.34-4.09) for a temporary stop and 1.33 (95% CI 0.51-3.42) for a definitive stop. CONCLUSION: Awarding a bachelor degree in the BaMa structure does not encourage students to interrupt or discontinue their medical study, to transfer to another master programme or to transfer to another medical school.

[The BETER survivorship care initiative for Hodgkin lymphoma; tailored survivorship care for late effects of treatment]. / BETER na hodgkinlymfoom; nazorg op maat voor langetermijneffecten van de behandeling.

The Dutch BETER consortium has established a national care infrastructure for Hodgkin lymphoma survivors. 'BETER' [the Dutch word for 'better'] stands for Better care after Hodgkin lymphoma (HL): Evaluation of long-term Treatment Effects and screening Recommendations. The survivorship care focuses on long-term effects of HL treatment. Over 10,000 HL survivors who were treated in the period spanning 1965-2008 have been identified. As part of the survivorship care initiative, specific BETER out-patient clinics have been set up. A dedicated website, www.beternahodgkin.nl, provides HL survivors with relevant information. The stakeholders of the BETER survivorship care programme aim to achieve an improved healthy life expectancy for patients treated for HL.

Improving calculation, interpretation and communication of familial colorectal cancer risk: protocol for a randomized controlled trial.

BACKGROUND: Individuals with multiple relatives with colorectal cancer (CRC) and/or a relative with early-onset CRC have an increased risk of developing CRC. They are eligible for preventive measures, such as surveillance by regular colonoscopy and/or genetic counselling. Currently, most at-risk individuals do not follow the indicated follow-up policy. In a new guideline on familial and hereditary CRC, clinicians have new tasks in calculating, interpreting, and communicating familial CRC risk. This will lead to better recognition of individuals at an increased familial CRC risk, enabling them to take effective preventive measures. This trial compares two implementation strategies (a common versus an intensive implementation strategy), focussing on clinicians' risk calculation, interpretation, and communication, as well as patients' uptake of the indicated follow-up policy. METHODS: A clustered randomized controlled trial including an effect, process, and cost evaluation will be conducted in eighteen hospitals. Nine hospitals in the control group will receive the common implementation strategy (i.e., dissemination of the guideline). In the intervention group, an intensive implementation strategy will be introduced. Clinicians will receive education and tools for risk calculation, interpretation, and communication. Patients will also receive these tools, in addition to patient decision aids. The effect evaluation includes assessment of the number of patients for whom risk calculation, interpretation, and communication is performed correctly, and the number of patients following the indicated follow-up policy. The actual exposure to the implementation strategies and users' experiences will be assessed in the process evaluation. In a cost evaluation, the costs of the implementation strategies will be determined. DISCUSSION: The results of this study will help determine the most effective method as well as the costs of improving the recognition of individuals at an increased familial CRC risk. It will provide insight into the experiences of both patients and clinicians with these strategies.The knowledge gathered in this study can be used to improve the recognition of familial and hereditary CRC at both the national and international level, and will serve as an example to improve care for patients and their relatives worldwide. Our results may also be useful in improving healthcare in other diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT00929097.

Lowering HbA1c in type 2 diabetics results in reduced risk of coronary heart disease and all-cause mortality.

AIMS: To assess to which extent lowering the level of HbA1c influences the 10-year risk of coronary heart disease (CHD) and all-cause mortality in patients with type 2 diabetes mellitus. METHODS: A literature search in Pubmed and Embase was performed, and the absolute risks in the results of the relevant and valid studies compared. RESULTS: Each study shows that with a decreasing percentage of HbA1c, both the risk of developing CHD and the risk of mortality decrease. CONCLUSIONS: Lowering HbA1c in type 2 diabetics decreases the absolute risk of developing CHD by 5-17%, as well as decreasing all-cause mortality by 6-15%.