To investigate the knowledge, professional involvement and confidence of Canadian nurses and physicians in providing genetic services for adult onset hereditary disease.
1,425 physicians and 1,425 nurses received a mailed questionnaire with reminders. The response rates were 50% (n = 543) and 79% (n = 975), respectively.
Forty-eight percent of physicians and 31% of nurses lacked formal education in genetics. Respondents reported being involved in caring for people at risk for adult onset hereditary disease. Their levels of confidence that they could perform tasks, such as counselling about predictive genetic tests, however, were lower than their levels of expectation that it would be important for them to provide these services.
The expected roles and educational needs of Canadian nurses and physicians have broad areas of overlap suggesting the possibility of combined professional education programs and multiple ways of organizing teams to provide genetic services to people at risk for adult onset hereditary disease.
The purpose of this qualitative study was to describe nurses' roles in providing clinical genetic services related to adult onset hereditary disease and factors that influence genetic nursing practice in Canada. The study involved semi-structured telephone interviews with 22 nurses from 5 Canadian provinces with full-time or part-time roles in providing genetic services. The interviews included open-ended questions to elicit descriptions of genetic nursing roles and factors that support and limit opportunities in genetic nursing practice. Thematic analysis of the transcribed interviews revealed that, in addition to genetic counselling, the nurses reported a wide range of roles and responsibilities related to the provision of genetic services that drew directly on their nursing background (e.g., patient assessment, health promotion). Factors identified as supporting genetic nursing roles included nursing background, being part of a multidisciplinary team, and receiving mentorship. Challenges in establishing roles in genetic nursing were related to role ambiguity, lack of recognition of nursing expertise, limited availability of genetics education, isolation, and instability of nursing positions. Recommendations to support the development and expansion of genetic nursing practice were identified. A coordinated national effort among all stakeholders is needed to provide the resources necessary to support the appropriate and effective use of nursing expertise as genetics is integrated into the Canadian health-care system.
Men's smoking is largely under-examined despite research that has consistently linked partner smoking to pregnant women's smoking and smoking relapse in the postpartum. An on-going qualitative study involving 31 couples in Canada exploring the influence of couple interactions on women's tobacco reduction provided the opportunity to examine men's smoking in the context of women's tobacco reduction or cessation during pregnancy and postpartum. Individual open-ended interviews with 20 men who smoked were conducted at 0-6 weeks following the birth of their infants and again at 16-24 weeks postpartum. Constant comparative methods were used along with social constructivist perspectives of fatherhood and gender to guide data analysis and enhance theoretical sensitivity. Four themes emerged in men's accounts of their tobacco use: (1) expressing masculinity through smoking, (2) reconciling smoking as a family man, (3) losing the freedom to smoke, and (4) resisting a smoke-less life. Men's reliance on and commitment to dominant ideals of masculinity seemed to preclude them from viewing their partner's tobacco reduction or cessation for pregnancy as an opportunity for cessation. Expectant and new fathers who smoke, however, may be optimally targeted for cessation interventions because it is a time when men experience discomfort with their smoking and when discontinuities in everyday life associated with the transition to fatherhood and presence of a new baby provide opportunities for establishing new routines. Implications for gender-sensitive smoking cessation interventions are discussed.
We tested an intervention to help smokers abstain (fast) from smoking before surgery, maintain abstinence postoperatively, and achieve long-term cessation. A randomized experiment included 237 patients admitted for presurgical assessment who smoked. The intervention included counseling and nicotine replacement therapy. Treatment group participants (73.0%) were more likely to fast than were controls (53.0%): chi(2)(1, N = 228) = 8.89, p =.003, and more likely to be abstinent 6 months after surgery (31.2% vs. 20.2%). There was no significant difference in the abstinence rates at 12 months after surgery, chi(2)(1, N = 169)
To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine arts have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients.
Interviews with mothers who smoke were analyzed to examine the influence of social discourses. Women presented themselves as knowledgeable about the health risks of tobacco, confessed guilt and shame, attempted to deflect accusations of neglect for smoking or exposing their children to tobacco, provided rationalization that they smoked for the sake of their children, and, although they were all smokers, demonstrated an antismoking stance. The findings indicate that mothers are in a "bind" when it comes to smoking and fulfilling societal expectations of a good mother. Health professionals must be cognizant of how discourses constrain women's choices in relation to tobacco.
The objective of this study was to assess women's interest in genetic testing for breast cancer risk. Randomly selected samples of 761 women without breast cancer from the general population of British Columbia, Canada, and 260 women with breast cancer from the provincial cancer registry participated in a telephone survey that assessed interest in genetic testing for breast cancer risk, knowledge of hereditary breast cancer and genetic testing, and sociodemographics. Women with breast cancer did not possess superior knowledge of breast cancer genetics compared with women from the general population. Of the women with breast cancer, 30.8% reported interest in testing or had been tested, compared with 28.5% of women without breast cancer. Controlling for differences in age, education, personal history of breast cancer, and knowledge of genetics, women with at least one relative with breast cancer were 2.3 times more likely to express interest in genetic testing for breast cancer risk than those with no family history. There were significant interactions between breast cancer status and education and between age and knowledge of breast cancer genetics. Women without breast cancer and with a positive family history, who were between 20 and 40 years of age, were most likely to be interested in testing. The women with breast cancer who were interested in testing tended to be approximately 50 years of age, had a positive family history, and had more years of education. Women with a family history of breast cancer, well-educated women with breast cancer, and younger women, particularly those with knowledge of genetic testing, are important target audiences for community-based education on genetic testing for breast cancer risk.