The state of genomic health care and cancer. Are we going two steps forward and one step backward?

As the application of genomic information and technology crosses the horizon of health care into our everyday lives, expanding genomic knowledge continues to affect how health care services are defined and delivered. Genomic discoveries have led to enhanced clinical capabilities to predict susceptibility to common diseases and conditions such as cancer, diabetes, cardiovascular disease, and Alzheimer's disease. Hundreds of genetic tests are now available that can identify individuals who carry one or more gene mutations that increase their risk of developing cancer or other common diseases. Increased availability and direct-to-consumer marketing of genetic testing is moving genetic testing away from trained genetics health professionals and into the hands of primary care providers and consumers. Genetic tests available on the Internet are being directly marketed to individuals, who can order these tests and receive a report of their risk for numerous health conditions and diseases. Health care providers are expected to interpret these test results, evaluate their accuracy, address the psychosocial consequences of those distressed by receiving their results, and translate genomic information into effective care. However, as we move two steps forward, we are also moving one step backward because many health care providers are unprepared for this genomic revolution. A number of international education, practice, and policy efforts are underway to address the challenges health care providers face in providing competent genomic health care in the context of unprecedented access to information, technology, and global communication. Efforts to integrate standard of care guidelines into electronic medical records increases health care providers' access to information for individuals at risk fo or diagnosed with a genomic condition. Development of genomic competencie for health care providers has led to increased genomic content in academic pro grams. These and other efforts will keep the state of genomic health care stepping forward as we face the challenges of health care in the genomic era.

Development of the essential genetic and genomic competencies for nurses with graduate degrees.

Scientific advances in genetics and genomics are rapidly redefining our understanding of health and illness and creating a significant shift in practice for all health care disciplines. Nurses educated at the graduate level are well-prepared to assume clinical and leadership roles in health care systems and must also be prepared to assume similar roles related to genetic/genomic health care. This chapter describes the processes used to create a consensus document identifying the genetic/genomic competencies essential for nurses prepared at the graduate level. Three groups were involved in the competency development; a steering committee provided leadership and used qualitative methods to review and analyze pertinent source documents and create an initial competency draft; an advisory board evaluated and revised the draft, and a consensus panel refined and validated the final set of competencies. The concensus process resulted in 38 competencies organized under the following categories: risk assessment and interpretation; genetic education, counseling, testing and results interpretation; clinical management; ethical, legal, and social implications; professional role; leadership, and research. These competencies apply to all individuals functioning at the graduate level in nursing, including but not limited to advanced practice registered nurses, clinical nurse leaders, nurse educators, nurse administrators, and nurse scientists and are intended to inform and guide their practice.

Teaching strategies to incorporate genomics education into academic nursing curricula.

The translation of genomic science into health care has expanded our ability to understand the effects of genomics on human health and disease. As genomic advances continue, nurses are expected to have the knowledge and skills to translate genomic information into improved patient care. This integrative review describes strategies used to teach genomics in academic nursing programs and their facilitators and barriers to inclusion in nursing curricula. The Learning Engagement Model and the Diffusion of Innovations Theory guided the interpretation of findings. CINAHL, Medline, and Web of Science were resources for articles published during the past decade that included strategies for teaching genomics in academic nursing programs. Of 135 articles, 13 met criteria for review. Examples of effective genomics teaching strategies included clinical application through case studies, storytelling, online genomics resources, student self-assessment, guest lecturers, and a genetics focus group. Most strategies were not evaluated for effectiveness.

Mammography decision making in older women with a breast cancer family history.

PURPOSE: This study's purpose is to describe and explain how women 55 years of age and older with a family history of breast cancer make screening mammography decisions. DESIGN: A qualitative design based on grounded theory. This purposeful sample consisted of 23 women 55 years of age or older with one more first-degree relatives diagnosed with breast cancer. METHOD: Open-ended interviews were conducted with 23 women 55 years of age and older with a family history of breast cancer using a semistructured interview guide. Transcribed interview data were analyzed using constant comparative analysis to identify the conditions, actions, and consequences associated with participant's screening mammography decision making. FINDINGS: Women reported becoming aware of their breast cancer risk usually due to a triggering event such as having a family member diagnosed with breast cancer, resulting in women "guarding against cancer." Women's actions included having mammograms, getting health check-ups, having healthy behaviors, and being optimistic. Most women reported extraordinary faith in mammography, often ignoring negative mammogram information. A negative mammogram gave women peace of mind and assurance that breast cancer was not present. Being called back for additional mammograms caused worry, especially with delayed results. CONCLUSIONS: The "guarding against cancer" theory needs to be tested in other at-risk populations and ultimately used to test strategies that promote cancer screening decision making and the adoption of screening behaviors in those at increased risk for developing cancer. CLINICAL RELEVANCE: Women 55 years of age and older with a breast cancer family history need timely mammogram results, mammography reminders, and psychosocial support when undergoing a mammography recall or other follow-up tests.

Identifying genetics and genomics nursing competencies common among published recommendations.

The purpose of this article is to identify published recommendations for genetics and genomics competencies or curriculum for nurses in the United States and to summarize genetic and genomic nursing competencies based on common themes among these documents. A review of the literature between January 1998 and June 2008 was conducted. Efforts were also made to access the gray literature. Five consensus documents describing recommendations for genetics and genomics competencies for nurses meeting inclusion criteria were analyzed. Twelve genetics and genomics competencies were created based on common themes among the recommendations. These competencies include: demonstrate an understanding of basic genetic and genomic concepts, provide and explain genetic and genomic information, refer to appropriate genetics professionals and services, and identify the limits of one's own genetics and genomics expertise. The competencies represent fundamental genetics and genomics competencies for nurses on the basis of common themes among several consensus recommendations identified in the literature.

Common hereditary cancer syndromes.

OBJECTIVES: To review cancer risk assessment and counseling, hereditary cancer syndrome risk factors, indicators for cancer predisposition testing, and interpretation of genetic test results. DATA SOURCES: Research studies, review articles, and authors' experience. CONCLUSION: Approximately 10% of those with a diagnosis of cancer may have a hereditary predisposition. In many cases genetic testing for susceptibility genes may be available. Knowledge of the results of genetic testing can be helpful when developing a plan for cancer prevention and early detection, and addressing concerns associated with genetic testing with the individual and family. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to know how to access genetic resources and to identify, evaluate, and care for patients and families at risk of or diagnosed with common hereditary cancer syndromes.

Nursing in the genomic era: nurturing our genetic nature.

Now that sequencing the human genome is completed, nurses are challenged with applying this genetic information to nursing practice. Nursing has moved from the "old genetics" to the "new genetics," with the recognition that common diseases such as cancer and heart disease result from complex interactions between genetic factors and a variety of environmental exposures that trigger, accelerate, or exacerbate the disease process. The profession has moved to a model of Nurturing Our Genetic Nature where nursing care is affected by genetic influences on health, illness, and behavior and the interaction of genetic and environmental factors.